Mapping the future for research in emergency medicine palliative care: A research roadmap

Abstract

Background The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. Objective The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. Methods Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. Results Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. Conclusions There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.

Identifying emergency department patients with life‐limiting illnesses may be getting a little easier

“…In this case, admission could be avoided, if the ED clinician was planning to admit the patient solely to have palliative care needs addressed. These and other models of care will require fidelity testing, evaluation of effectiveness, and measurement of sustainability 13 …”

“…These and other models of care will require fidelity testing, evaluation of effectiveness, and measurement of sustainability. 13 Still, the availability of a valid screening tool that does not expend additional clinician effort is an important new development for older patients seen in the ED. Automated screening could prompt the ED clinician to assess palliative care needs when they previously did not, it could improve appropriate identification of patients near the end of life, and could substantiate ED operation team requests to create robust palliative care consult services by showing the mismatch between demand and supply.…”