Ouchi Kei, Wu Mark, Medairos Robert, Grudzen Corita R, Balsells Herberth, Marcus David, Whitson Micah, Ahmad Danish, Duprey Kael, Mancherje Noel, Bloch Helen, Jaffrey Fatima, Liberman Tara
1 Department of Emergency Medicine, Long Island Jewish Medical Center , New Hyde Park, New York.
J Palliat Med. 2014 Mar;17(3):346-50. doi: 10.1089/jpm.2013.0285. Epub 2014 Jan 4.
Patients with dementia, an underrecognized terminal illness, frequently visit the emergency department (ED). These patients may benefit from ED-initiated palliative care (PC) consultation.
The study's objective was to track the rate of ED-initiated PC consultation for patients with advanced dementia (AD) after an educational intervention, and to categorize decision making for physicians who chose not to initiate consultation.
As part of a quality improvement project at a suburban, tertiary care, university-affiliated medical center, emergency physicians (EPs) were taught to identify AD patients and initiate PC consultation. A convenience sample of patients over age 70 was screened for AD by research staff from July 1, 2012 to August 1, 2012 using the Functional Assessment Staging (FAST) criteria. A questionnaire was then administered to patients' physicians to inquire about barriers to initiating consultation. Questionnaires and medical records of those who met AD criteria were reviewed to examine patient characteristics, disposition information, and consultation initiation barriers.
Patients (N=548) over 70 who visited the ED were approached and 304 completed the screening. Fifty-one of the 304 met criteria for AD. Their average age was 86; 33% were male. Eighteen of the 51 (35%) patients received a PC consultation sometime during their ED or hospital stay. Four of the 18 (22%) consultations were ED initiated. In 23 of 51 (45%) unique cases, physicians responded to the questionnaire. The majority felt that a PC consult was not appropriate for patients based on their knowledge, attitudes, or beliefs.
Preexisting physician attitudes, knowledge, and beliefs prevent emergency physicians from addressing PC needs for AD patients.
痴呆症是一种未得到充分认识的终末期疾病，患者经常前往急诊科（ED）就诊。这些患者可能会从急诊科发起的姑息治疗（PC）咨询中受益。
本研究的目的是追踪教育干预后晚期痴呆症（AD）患者由急诊科发起的PC咨询率，并对选择不发起咨询的医生的决策进行分类。
作为一家郊区三级医疗大学附属医院质量改进项目的一部分，急诊医生（EPs）被教导识别AD患者并发起PC咨询。2012年7月1日至2012年8月1日，研究人员使用功能评估分期（FAST）标准对70岁以上的便利样本患者进行AD筛查。然后向患者的医生发放问卷，询问发起咨询的障碍。对符合AD标准的患者的问卷和病历进行审查，以检查患者特征、处置信息和咨询发起障碍。
接触了70岁以上到急诊科就诊的患者（N = 548），304人完成了筛查。304人中51人符合AD标准。他们的平均年龄为86岁；33%为男性。51名患者中有18名（35%）在急诊科或住院期间的某个时间接受了PC咨询。18次咨询中有4次（22%）是由急诊科发起的。在51例（45%）不同病例中，23名医生回复了问卷。大多数医生认为，基于他们的知识、态度或信念，PC咨询对患者不合适。
医生原有的态度、知识和信念阻碍了急诊医生满足AD患者的PC需求。
