Early Palliative Care in the Emergency Department: A Concept Clarification

Abstract

Introduction: Healthcare advances have contributed to patients living longer with chronic illnesses and diseases with uncertain trajectories impacting quality of life (QOL). Palliative care (PC) is no longer only for dying oncology patients as many healthcare practitioners have adopted the PC concept in diverse care settings and the timing of PC implementation remains ambiguous. There is a need to develop an operational definition of early palliative care (EPC) by clarifying the phenomenon and bridging concepts with empirical data to develop and test possible interventions before integrating EPC into emergency care (EC). Methods: Norris’ concept clarification method was used as the philosophical framework to define, analyze, and clarify EPC. An electronic search of literature from 2000-2024, using CINAHL, PubMed, APA PsychINFO, and Psychology and Behavioral Sciences Collection databases and search terms "early palliative care" AND "emergency care" NOT "animals", and NOT "pediatrics" were screened for eligible articles. Results: Of the 826 articles identified; 22 articles were retained for review. Attributes included timing, palliative, and EC; antecedents included symptom burden, access to care, and cognitive awareness; consequences included QOL and resource utilization; an empirical referent used to screen patients is the highly accurate surprise question "Would I be surprised if this patient died within a year?" Conclusion: Clarifying the concept of EPC leading to an operational definition will advance the development of interventions that support the implementation of EPC in ED clinical practice.