1
|
Chwallek D, Schweda A, Neukirchen M, Risse J, Hense J, Teufel M, Tewes M. Comparison of Palliative Knowledge and Self-Efficacy Expectation of German Paramedics Between a Rural and an Urban Structured Emergency Medical Service Area. J Palliat Care 2024:8258597231221916. [PMID: 38374646 DOI: 10.1177/08258597231221916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE(S) Differences in the German emergency medical service (EMS) can be seen in the countryside in contrast to the city with regard to travel distances to hospitals and in the access routes of EMS-physicians. In order to investigate the success of establishment of palliative crisis cards associated with training and the rural and urban EMS structures, two urban and two rural EMS areas were compared using the Paramedic Palliative Care Test (PARPACT). Methods: The PARPACT includes test items on palliative knowledge (PK, maximum score: 15 points) and palliative self-efficacy expectations (PSE, maximum score: 18 points), as well as items on palliative attitudes in dealing with palliative care patients. We used a 4-point Likert-type scale. For data analysis, nonparametric tests (χ-test and Mann-Whitney U test) were used in addition to descriptive analysis (frequencies, means, medians, standard deviations, and ranges). Results: In total, 291 out of 750 ambulance or EMS personnel participated in the voluntary survey. Rural ambulance or EMS personnel answered the PK-questions correctly more often on average (mean: 11.19, SD: 1.85) than urban ambulance or EMS personnel (mean: 9.18, SD: 2.39; Mann-Whitney U test: U=5040.000, P=.001). In addition, ambulance or EMS personnel with the highest level of training (3-year-trained paramedics) performed better in PK (mean: 10.38, SD: 2.31) than less intensively training ambulance or EMS personnel (mean: 9.58, SD: 2.43; Mann-Whitney U-test: U=8446.500, P=.004). In terms of PSE, rural ambulance or EMS personnel also achieved higher mean PSE-scores (mean: 12.55, SD: 2.60) than urban ambulance or EMS personnel (mean: 9.77, SD: 3.41; Mann-Whitney U-test: U=5148.500, P=.001). Conclusions: Better training in the EMS is associated with improved PK compared to less qualified nonphysician EMS staff. The establishment of palliative crisis cards and the structures in the city alone do not lead to improved knowledge and PSE.
Collapse
Affiliation(s)
- Daniel Chwallek
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adam Schweda
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Martin Neukirchen
- Interdisciplinary Centre of Palliative Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Jörg Hense
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
2
|
Böhm L, Schwartz J, Michael M, Diehl-Wiesenecker E, Bernhard M, Neukirchen M. [Survey on the presence of palliative care knowledge and palliative care structures in German emergency departments]. DIE ANAESTHESIOLOGIE 2023; 72:863-870. [PMID: 37994928 PMCID: PMC10692016 DOI: 10.1007/s00101-023-01356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 11/24/2023]
Abstract
Patients with life-limiting or palliative illnesses represent a challenge for emergency departments because, despite the growing availability of specialized outpatient palliative care resources at home, patients often present during symptom exacerbations or when family caregivers become overwhelmed. Also, as life-limiting illnesses are frequently first diagnosed there and treatment goals are adjusted, it appears advantageous to establish early connections between emergency patients with palliative needs and palliative care resources. The objective of this study was to conduct a survey evaluating the availability of fundamental palliative care knowledge and palliative care structures in clinical acute and emergency medicine. For this purpose, an online survey was distributed via emergency medicine blogs, targeting physicians working in emergency departments. In total, 383 fully completed questionnaires were analyzed. It was found that the respondents often encounter patients with palliative needs. However, both outpatient and inpatient palliative resources are not universally accessible, and where, for instance, consultation services are available, there is a lack of consensus regarding the appropriate timing for their utilization. Structures for end of life care are largely in place, although time and personnel are often insufficiently available. There is an expressed interest in further education and training in palliative care. In conclusion, as emergency departments serve as the interface between outpatient and inpatient care, an interdisciplinary and holistic approach can be employed to lay the groundwork for ongoing palliative care, benefiting patients with palliative needs.
Collapse
Affiliation(s)
- Lennert Böhm
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
- Arbeitsgruppe "Ethik" der Deutschen Gesellschaft für Interdisziplinäre Notfall- und Akutmedizin (DGINA e. V.), Berlin, Deutschland
| | - Jacqueline Schwartz
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Mark Michael
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Eva Diehl-Wiesenecker
- Arbeitsgruppe "Ethik" der Deutschen Gesellschaft für Interdisziplinäre Notfall- und Akutmedizin (DGINA e. V.), Berlin, Deutschland
- Zentrale Notaufnahme und Aufnahmestation, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| |
Collapse
|
3
|
Gage CH, Stander C, Gwyther L, Stassen W. Emergency medical services and palliative care: a scoping review. BMJ Open 2023; 13:e071116. [PMID: 36927584 PMCID: PMC10030966 DOI: 10.1136/bmjopen-2022-071116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present? DESIGN A scoping review of literature was performed with an a priori search strategy. DATA SOURCES MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. RESULTS In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS' palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration. CONCLUSION EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.
Collapse
Affiliation(s)
- Caleb Hanson Gage
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Charnelle Stander
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Liz Gwyther
- Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| |
Collapse
|
4
|
Juhrmann ML, Grindrod AE, Gage CH. Emergency medical services: the next linking asset for public health approaches to palliative care? Palliat Care Soc Pract 2023; 17:26323524231163195. [PMID: 37063113 PMCID: PMC10102939 DOI: 10.1177/26323524231163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
Collapse
Affiliation(s)
| | - Andrea E. Grindrod
- Public Health Palliative Care Unit, School of
Psychology and Public Health, La Trobe University, Melbourne, VIC,
Australia
| | - Caleb H. Gage
- Division of Emergency Medicine, University of
Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Gage CH, Stander C, Gwyther L, Stassen W. Emergency medical services and palliative care: protocol for a scoping review. BMJ Open 2022; 12:e062054. [PMID: 36428019 PMCID: PMC9703319 DOI: 10.1136/bmjopen-2022-062054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The purpose of emergency medical services (EMS) is to preserve life and limb in emergency situations. Palliative care, however, is not concerned with 'life-saving' measures, but the prevention and relief of suffering. While these care goals appear to conflict, EMS and palliative care may be complementary if integrated. The aim of this scoping review is to map existing literature concerning EMS and palliative care by identifying literature types, extracting key findings and noting limitations using descriptive analysis. METHODS AND ANALYSIS The framework of Arksey and O'Malley will direct this review. The following databases will be searched: MEDLINE via PubMed, Web of Science, CINAHL, Embase and PsycINFO. In addition, the University of Cape Town Thesis Repository and Google Scholar will be searched for relevant grey literature. Empirical studies concerning EMS and palliative care published between January 2000 and September 2021 will be included. Article selection will be performed and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Extracted data from included articles will undergo descriptive analysis with findings being reported in a discussion format. ETHICS AND DISSEMINATION This review will identify and describe existing literature concerning EMS and palliative care, highlighting key findings and knowledge gaps in the subject area. Findings will be disseminated to relevant stakeholders through peer-reviewed, open-access journal publication. As no participants will be involved and selected literature is publicly available, no ethical approval will be required.
Collapse
Affiliation(s)
- Caleb Hanson Gage
- Health Sciences, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Charnelle Stander
- University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Liz Gwyther
- Division of Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Surakka LK, Hökkä M, Törrönen K, Mäntyselkä P, Lehto JT. Paramedics' experiences and educational needs when participating end-of-life care at home: A mixed method study. Palliat Med 2022; 36:1217-1227. [PMID: 35922966 DOI: 10.1177/02692163221105593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. AIM To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. DESIGN A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. SETTING/PARTICIPANTS The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. RESULTS Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. CONCLUSIONS Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future.
Collapse
Affiliation(s)
- Leena K Surakka
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Siun Sote - North Karelia Social and Health Services Joint Authority, Palliative Care Center, Joensuu, Finland
| | - Minna Hökkä
- Kajaani University of Applied Sciences, Kajaani, Finland.,Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kari Törrönen
- Fire and Rescue Department, Siun Sote - North Karelia Social and Health Services Joint Authority, Joensuu, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Oncology, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
7
|
Khalil H, Leach MJ, Bolton E, Spargo M, Byrne A, Ristevski E. Rural nurses’ self-rated knowledge and skills in pain, medication, symptom and emergency management in community-based palliative care: A cross-sectional survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Juhrmann ML, Vandersman P, Butow PN, Clayton JM. Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis. Palliat Med 2022; 36:405-421. [PMID: 34852696 PMCID: PMC8972966 DOI: 10.1177/02692163211059342] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing demand for community palliative care and home-based deaths worldwide. However, gaps remain in this service provision, particularly after-hours. Paramedicine may help to bridge that gap and avoid unwanted hospital admissions, but a systematic overview of paramedics' potential role in palliative and end-of-life care is lacking. AIM To review and synthesise the empirical evidence regarding paramedics delivering palliative and end-of-life care in community-based settings. DESIGN A systematic integrative review with a thematic synthesis was undertaken in accordance with Whittemore and Knafl's methodology. Prospero: CRD4202119851. DATA SOURCES MEDLINE, CINAHL, PsycINFO and Scopus databases were searched in August 2020 for primary research articles published in English, with no date limits applied. Articles were screened and reviewed independently by two researchers, and quality appraisal was conducted following the Mixed-Methods Appraisal Tool (2018). RESULTS The search retrieved 5985 articles; 23 articles satisfied eligibility criteria, consisting of mixed-methods (n = 5), qualitative (n = 7), quantitative descriptive (n = 8) and quantitative non-randomised studies (n = 3). Through data analysis, three key themes were identified: (1) Broadening the traditional role, (2) Understanding patient wishes and (3) Supporting families. CONCLUSIONS Paramedics are a highly skilled workforce capable of helping to deliver palliative and end-of-life care to people in their homes and reducing avoidable hospital admissions, particularly for palliative emergencies. Future research should focus on investigating the efficacy of palliative care clinical practice guideline implementation for paramedics, understanding other healthcare professionals' perspectives, and undertaking health economic evaluations of targeted interventions.
Collapse
Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,HammondCare Centre for Learning and Research in Palliative Care, Greenwich Hospital, Greenwich, NSW, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care, Death and Dying, Flinders University of South Australia, Adelaide, SA, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group and Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia
| | - Josephine M Clayton
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,HammondCare Centre for Learning and Research in Palliative Care, Greenwich Hospital, Greenwich, NSW, Australia
| |
Collapse
|
9
|
Peran D, Uhlir M, Pekara J, Kolouch P, Loucka M. Approaching the End of Their Lives Under Blue Lights and Sirens - Scoping Review. J Pain Symptom Manage 2021; 62:1308-1318. [PMID: 33989706 DOI: 10.1016/j.jpainsymman.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Emergency medical services (EMS) are frequently responding to calls involving patients in advanced stages of incurable diseases. Despite the competencies and potential of EMS in supporting patients and their families facing symptoms of advanced progressive illnesses, the role of EMS in providing palliative care remains unclear. OBJECTIVE The following research question was formulated: What is the role of ambulance EMS, EMS dispatch centres, paramedics and emergency medical physicians in the provision of palliative care to terminally ill patients? METHODS Following PRISMA-ScR guidelines, online bibliographic databases CINAHL Complete, MEDLINE Complete (EBSCO), PubMed and MEDLINE (Ovid) were searched from the initial year of database to September 2019. No language restrictions were applied. RESULTS 31 articles were included in the qualitative synthesis and 3 main roles and one contextual factor were identified: (1) Providing complex care; (2) Adjusting patient's trajectory; (3) Being able to make decisions in a time and information limited environment; (4) Health care professionals are insufficiently supported in palliative care. CONCLUSION There are limited data on the incidence of EMS calls to the patients at the end-of-life and no data focusing on the EMS dispatch centres. Both paramedics and emergency physicians are aware of their role in the end-of-life care. EMS personnel are lacking special training and education in the palliative care. Cooperation between palliative care providers, the EMS providers and other out-of-hours services might improve the responsiveness of the health care system to needs and expectations of patients and their families, and possibly improve the overall health care system efficiency.
Collapse
Affiliation(s)
- David Peran
- Prague Emergency Medical Services, Prague, Czech Republic; Divisions of Public Health, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Medical College, Prague, Czech Republic.
| | - Marek Uhlir
- Prague Emergency Medical Services, Prague, Czech Republic; Centre for Palliative Care, Prague, Czech Republic
| | - Jaroslav Pekara
- Prague Emergency Medical Services, Prague, Czech Republic; Medical College, Prague, Czech Republic
| | - Petr Kolouch
- Prague Emergency Medical Services, Prague, Czech Republic
| | | |
Collapse
|
10
|
Peyrony O, Fontaine JP, Trabattoni E, Nakad L, Charreyre S, Picaud A, Bosc J, Viglino D, Jacquin L, Laribi S, Pereira L, Thiriez S, Paquet AL, Tanneau A, Azoulay E, Chevret S. Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER. J Clin Med 2021; 10:jcm10051145. [PMID: 33803366 PMCID: PMC7967166 DOI: 10.3390/jcm10051145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.
Collapse
Affiliation(s)
- Olivier Peyrony
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-4249-8404
| | - Jean-Paul Fontaine
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
| | | | - Lionel Nakad
- Emergency Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France;
| | - Sylvain Charreyre
- Emergency Department, SAMU de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
- University Claude Bernard Lyon 1, 69007 Lyon, France
| | - Adrien Picaud
- Emergency Department, SAMU, SMUR. Le Mans Hospital, 72181 Le Mans, France;
| | - Juliane Bosc
- Emergency Department, SMUR. Libourne and Sainte Foy la Grande Hospital, 33243 Libourne, France;
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France;
- HP2 INSERM U 1042 University Grenoble-Alpes, 38043 Grenoble, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, 37000 Tours, France;
| | - Laurent Pereira
- Emergency Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France;
| | - Sylvain Thiriez
- Emergency Department, SMUR, Victor Provo Hospital, Roubaix Hospital, 59100 Roubaix, France;
| | - Anne-Laure Paquet
- Emergency Department, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Sorbonne-UPMC-Paris VI University, 75005 Paris, France
| | - Alexandre Tanneau
- Emergency Department, SMUR of Lorient and Quimperlé, Bretagne Sud Hospital Group, 56322 Lorient, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | | |
Collapse
|
11
|
James HSE, Smith AC, Thomas EE, Snoswell CL, Caffery LJ, Haydon HM. Exploring paramedics’ intention to use a specialist palliative care telehealth service. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1852657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - A. C. Smith
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - E. E. Thomas
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - C. L. Snoswell
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - L. J. Caffery
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - H. M. Haydon
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| |
Collapse
|
12
|
South African paramedic perspectives on prehospital palliative care. BMC Palliat Care 2020; 19:153. [PMID: 33032579 PMCID: PMC7545550 DOI: 10.1186/s12904-020-00663-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.
Collapse
|
13
|
Mott C, Herbert A, Malcolm K, Sansone H, Agar M. Emergencies in Pediatric Palliative Care: A Survey of Ambulance Officers to Understand the Interface between Families and Ambulance Services. J Palliat Med 2020; 23:1649-1652. [PMID: 32176562 DOI: 10.1089/jpm.2019.0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pediatric palliative care occurs across contexts through the child's illness trajectory, including within the child or young person's community. Interactions with the ambulance service may occur with a child's deterioration, crisis, or when needing transfer, but there is little research on this interaction. Aim: To explore the experiences and attitudes of ambulance officers in managing pediatric patients with palliative care needs. Design: A targeted e-mail survey was sent exploring perceptions of the involvement with these patients including exposure, comfort, resuscitation topics, and supports available. Setting/Participants: Participants were Queensland ambulance officers known to have had an interaction with one of the last 50 pediatric palliative care referrals across Queensland. Results: Twenty-two survey responses were received. Most of the palliative group accessed ambulances for the 13-month study period. Most ambulance officers did not easily identify patients as receiving palliative care. Many participants felt these cases were challenging, confidence levels varied, and staff counselling services were felt to be relevant. Ambulance officers were most likely to use correspondence provided by the family from their usual team as a guide for emergency management. Half of the participants felt patients receiving pediatric palliative care should have a "not for resuscitation" order. Respondents suggested officer support could be improved through increased patient documentation and promotion of existing officer supports. Conclusions: These findings demonstrate challenges experienced by ambulance officers and suggest practical ways in which pediatric palliative care services can better support emergency services.
Collapse
Affiliation(s)
- Christine Mott
- Paediatric Palliative Care Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Centre for Children's Health Research at Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karel Malcolm
- Queensland Ambulance Service, Office of the Medical Director, Brisbane, Queensland, Australia
| | - Holly Sansone
- School of Psychology and Counseling, University of Technology, Brisbane, Queensland, Australia
| | - Meera Agar
- Palliative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Challenges Faced by Prehospital Emergency Physicians Providing Emergency Care to Patients with Advanced Incurable Diseases. Emerg Med Int 2019; 2019:3456471. [PMID: 31885924 PMCID: PMC6899297 DOI: 10.1155/2019/3456471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The aim of our study was to investigate challenges faced by emergency physicians (EPs) who provide prehospital emergency care to patients with advanced incurable diseases and family caregivers in their familiar home environment. Methods Qualitative study using semistructured interviews with open-ended questions to collect data from 24 EPs. Data were analyzed using qualitative content analysis. Results We identified nine categories of challenges: structural conditions of prehospital emergency care, medical documentation and orders, finding optimal patient-centered therapy, uncertainty about legal consequences, challenges at the individual (EP) level, challenges at the emergency team level, family caregiver's emotions, coping and understanding of patient's illness, patient's wishes, coping and understanding of patient's illness, and social, cultural, and religious background of patients and families. EPs strengthened that the integrations of specialized prehospital palliative care services improved emergency care by providing resources to patients and family caregivers, enhancing the quality and availability of medical documentation and accessibility of aftercare in emergencies. Areas of improvement that were identified were to promote emergency physicians' knowledge and skills in palliative care, communication, and family caregiver support by education and training. Furthermore, structures for better care on-site, thorough medical documentation, and specialized palliative care emergency facilities in hospital and prehospital care were requested. Conclusion Prehospital emergency care in patients with advanced incurable diseases in their familiar home environment may be improved by training EPs in palliative care, communication, and caregiver support competences. Results underline the importance of collaborative specialized palliative care and prehospital emergency care.
Collapse
|
15
|
Ferrer RA, Orehek E, Padgett LS. Goal conflict when making decisions for others. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2018. [DOI: 10.1016/j.jesp.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
16
|
[Outpatient palliative medicine : Attitudes in the care of palliative emergencies. Prospective questionnaire-based investigation]. Anaesthesist 2018; 67:216-224. [PMID: 29480318 DOI: 10.1007/s00101-018-0417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The right to adequate outpatient palliative care has existed for several years in Germany. In recent years outpatient palliative care has developed very positively. Nevertheless, in emergency situations paramedics and emergency physicians were often included in the care of palliative care of patients. The aim of our study was to investigate the cooperation between outpatient palliative care teams and the emergency medical services. Another aim was to identify structural realities and based on these to discuss the possibilities in the optimization of outpatient palliative medical emergency situations. METHODS A standardized self-designed questionnaire was distributed to specialized outpatient palliative care teams (SPCS) in Germany. For this purpose, closed and open questions (mixed methods) were used. The evaluation was carried out according to the questionnaire categories in quantitative and qualitative forms. The questionnaire was subdivided into general information and specific questions. RESULTS The survey response rate was 79% from a total of 81 SPCS in 2011. The following standards in palliative emergency care were recommended: (1) early integration of outpatient palliative care services and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, emergency drug boxes, do not attempt resuscitation orders and (4) emergency medical training (physicians and paramedics). CONCLUSION Outpatient palliative care in Germany has developed very positively during the last years; however, there are still deficits in terms of optimal patient care, one of which refers to the treatment of palliative care emergencies. In this context, optimization in the cooperation between outpatient palliative care services and emergency medical services should be discussed.
Collapse
|
17
|
Affiliation(s)
- Christoph Wiese
- HEH-Kliniken Braunschweig, Klinik für Anästhesiologie und Intensivmedizin, Leipziger Straße 24, D-38124, Braunschweig, Deutschland.
| | | | | |
Collapse
|
18
|
Miranda B, Vidal SA, Mello MJGD, Lima JTDO, Rêgo JC, Pantaleão MC, Leão VGC, Gusmão Filho FARD, Costa Júnior JID. Cancer patients, emergencies service and provision of palliative care. Rev Assoc Med Bras (1992) 2016; 62:207-11. [DOI: 10.1590/1806-9282.62.03.207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 05/04/2015] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011) with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%). 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%), breast (13.6%) and prostate (10.5%); 70.7% were in advanced stages (IV, 47.1%); 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.
Collapse
Affiliation(s)
- Bruno Miranda
- Instituto de Medicina Integral Prof. Fernando Figueira, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Murphy-Jones G, Timmons S. Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors. Emerg Med J 2016; 33:722-6. [DOI: 10.1136/emermed-2015-205405] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/24/2016] [Indexed: 11/03/2022]
|
20
|
Elsayem AF, Elzubeir HE, Brock PA, Todd KH. Integrating palliative care in oncologic emergency departments: Challenges and opportunities. World J Clin Oncol 2016; 7:227-33. [PMID: 27081645 PMCID: PMC4826968 DOI: 10.5306/wjco.v7.i2.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/01/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied.
Collapse
|
21
|
|
22
|
Trzeczak S. Das medizinisch-ethische Dilemma von Reanimationsentscheidungen bei Notfallpatienten. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1912-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Lamba S, Schmidt TA, Chan GK, Todd KH, Grudzen CR, Weissman DE, Quest TE. Integrating palliative care in the out-of-hospital setting: four things to jump-start an EMS-palliative care initiative. PREHOSP EMERG CARE 2013; 17:511-20. [PMID: 23968313 DOI: 10.3109/10903127.2013.811566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Emergency medical service (EMS) is frequently called to care for a seriously ill patient with a life-threatening or life-limiting illness. The seriously ill include both the acutely injured patients (for example in mass casualty events) and those who suffer from advanced stages of a chronic disease (for example severe malignant pain). EMS therefore plays an important role in delivering realistic, appropriate, and timely care that is consistent with the patient's wishes and in treating distressing symptoms in those who are seriously ill. The purpose of this article is to; 1) review four case scenarios that relate to palliative care and may be commonly encountered in the out-of-hospital setting and 2) provide a road map by suggesting four things to do to start an EMS-palliative care initiative in order to optimize out-of-hospital care of the seriously ill and increase preparedness of EMS providers in these difficult situations.
Collapse
Affiliation(s)
- Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Hjermstad MJ, Kolflaath J, Løkken AO, Hanssen SB, Normann AP, Aass N. Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open 2013; 3:bmjopen-2012-002515. [PMID: 23793662 PMCID: PMC3669727 DOI: 10.1136/bmjopen-2012-002515] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Patients with advanced cancer are often admitted to hospital as emergency cases. This may not always be medically indicated. Study objectives were to register the reasons for the emergency admissions, to examine interventions performed during hospitalisation and self-reported symptom intensity at admission and discharge, and to assess patients' opinions about the admission. DESIGN This was a descriptive before-and-after study. Participating patients completed the Edmonton Symptom Assessment System (ESAS) twice, upon hospital admission and prior to discharge. All patients underwent a structured interview assessing their opinion about the emergency admission. Medical data were obtained from the hospital records. SETTING The study was performed in two Norwegian acute care secondary hospitals with urban catchment areas. PARTICIPANTS 44 patients with cancer (men 27 and women 17; mean age 69.2, SD 9.2) representing 50 emergency admissions were included. RESULTS Median length of stay was 7 days (95% CI 7.4 to 11.4). Median survival was 50 days (95% CI 51 to 115). 90% were admitted from home, and 46% had been hospitalised less than 1 month earlier. Lung and gastrointestinal symptoms and pain were the most frequent reasons for admissions. Mean pain scores on ESAS were reduced by 50% from admission to discharge (p<0.01). Simple interventions such as hydration, bladder catheterisation and oxygen therapy were most frequent. Nearly one-third would have preferred treatment at another site, provided that the quality of care was similar. Home visits by the family doctor and specialised care teams were perceived by patients as important to prevent hospitalisation. CONCLUSIONS In most emergency admissions, relatively simple medical interventions are necessary. Specialised care teams with palliative care physicians, easier access to the family doctor and better lines of cooperation between hospitals and the primary care sector may make it possible to perform more of these procedures at home, thereby reducing the need for emergency admissions.
Collapse
Affiliation(s)
- Marianne Jensen Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Kolflaath
- Department of Anaesthesiology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Aud O Løkken
- Department of Anaesthesiology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Sjur B Hanssen
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
| | - Are P Normann
- Department of Medicine, Hospice Lovisenberg, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Nina Aass
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
25
|
Wiese CH, Lassen CL, Bartels UE, Taghavi M, Elhabash S, Graf BM, Hanekop GG. International recommendations for outpatient palliative care and prehospital palliative emergencies - a prospective questionnaire-based investigation. BMC Palliat Care 2013; 12:10. [PMID: 23432905 PMCID: PMC3602669 DOI: 10.1186/1472-684x-12-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. Methods One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical . Results The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics). Conclusions This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system.
Collapse
Affiliation(s)
- Christoph Hr Wiese
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany.
| | | | | | | | | | | | | |
Collapse
|
26
|
Análisis de la evolución de pacientes en probable situación de últimos días en un servicio de Urgencias. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.medipa.2012.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
27
|
Wiese CHR, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Schreiber-Winzig L, von Berswordt-Wallrabe M. [Palliative care oriented therapy for all patients : recommendations of an expert circle]. Anaesthesist 2012; 61:529-36. [PMID: 22695773 DOI: 10.1007/s00101-012-2025-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since 2011 palliative care has been a compulsory part of the German medical study course (so-called Q13 palliative and pain medicine). Palliative care content does not, however, as often taught, have to focus only on patients in the so-called palliative stages of disease. The aim of this investigation was to encourage a discussion concerning the integration of palliative care aspects into general medical treatment. METHODS For data collection an open discussion of the main topics by experts in palliative medical care was used. The main outcome measures and recommendations included responses regarding current practices related to expert opinions, national and international literature and one case report. The literature search was performed using the databases "PubMed", "Medline" and "Google" (1990-2011). RESULTS As an important consensus, the following recommendations for optimization of inpatient and outpatient care were: (1) integration of aspects of palliative care into medical curricula of all disciplines, (2) palliative care content should be extended to the general optimization of therapy for all patients, (3) palliative medicine should be part of the everyday medical practice in all disciplines and (4) palliative medicine should not be isolated as "death medicine" or medicine of the dying patient. CONCLUSIONS Palliative care treatment is increasingly becoming integrated into medical education and into medical curricula of all disciplines. Palliative ideas and goals are focussed on patients in the so-called palliative stages of disease. Furthermore, palliative medicine is often described as the medicine of dying patients. As a result of this study it seems to make sense to extend palliative care aspects to all patients and to all patient care. The extent to which such opportunities exist and such health care is economically feasible remains to be the subject of further clinical studies.
Collapse
Affiliation(s)
- C H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Limitation des thérapeutiques actives en médecine d’urgence préhospitalière. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
29
|
Taghavi M, Simon A, Kappus S, Meyer N, Lassen CL, Klier T, Ruppert DB, Graf BM, Hanekop GG, Wiese CHR. Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study. Palliat Med 2012; 26:908-16. [PMID: 21865293 DOI: 10.1177/0269216311419885] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions. AIM To examine paramedics' attitudes towards advance directives and end-of-life care. DESIGN Questionnaire-based investigation using a self-administered survey instrument. SETTING/PARTICIPANTS Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards. RESULTS Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care. CONCLUSIONS Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.
Collapse
|
30
|
|
31
|
Wiese CHR, Felber S, Lassen CL, Klier TW, Meyer N, Graf BM, Zausig YA, Hanekop GG. [Anesthesiology and palliative medicine. Structured results of a prospective questionnaire-based survey in German hospitals]. Schmerz 2011; 25:522-33. [PMID: 21901567 DOI: 10.1007/s00482-011-1090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anesthesiology departments were often integrated into the primary formation of palliative activities in Germany. The aim of this study was to present the current integration of anesthesiology departments into palliative care activities in Germany. METHODS The objective was to determine current activities of anesthesiology departments in in-hospital palliative care. A quantitative study was carried out based on a self-administered structured questionnaire used during telephone interviews. RESULTS A total of 168 out of 244 hospitals consented to participate in the study and the response rate was 69%. In-hospital palliative care activities were reported for most of the surveyed hospitals. Only two hospitals in the maximum level of care reported no activities. Participation in these activities by anesthesiology departments was described in up to 92%. Historically, most activities are due to the commitment of individuals, whereas the development of palliative care of cancer pain services and hospital support teams took place in the university hospitals by 2005. CONCLUSIONS Until 2005 many university palliative care activities had their origins in cancer pain services. These were often integrated into anesthesiology departments. Currently, anesthesiology departments work as an integrative part of palliative medicine. However, it appears from the present results that there is a domination of internal medicine (especially hematology and oncology) in palliative activities in German hospitals. This allows the focus of palliative activities to be formed by subjective specialist interests. Such a state seems to be reduced by the integration of anesthesiology departments because of their neutrality with respect to faculty-specific medical interests. Advantages or disadvantages of these circumstances are not considered by the present investigation.
Collapse
Affiliation(s)
- C H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Wiese CHR, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Graf BM, Zausig YA. [Palliative care and end-of-life patients in emergency situations. Recommendations on optimization of out-patient care]. Anaesthesist 2011; 60:161-71. [PMID: 21184035 DOI: 10.1007/s00101-010-1831-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients. METHODS For data collection an open discussion of the main topics by experts in palliative and emergency medical care was employed. Main outcome measures and recommendations included responses regarding current practices related to expert opinions and international literature sources. RESULTS As the essential points of consensus the following recommendations for optimization of care were named: (1) integration of palliative care in the emergency medicine curricula for pre-hospital emergency physicians and paramedics, (2) development of outpatient palliative care, (3) integration of palliative care teams into emergency medical structures, (4) cooperation between palliative and emergency medical care, (5) integration of crisis intervention into outpatient palliative emergency medical care, (6) provision of emergency plans and emergency medical boxes, (7) provision of palliative crisis cards and do not attempt resuscitation (DNAR) orders, (8) psychosocial aspects concerning palliative emergencies and (9) definition of palliative patients and their special situation by the physician responsible for prior treatment. CONCLUSIONS Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.
Collapse
Affiliation(s)
- C H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Wiese CHR, Bartels UE, Zausig YA, Pfirstinger J, Graf BM, Hanekop GG. Prehospital emergency treatment of palliative care patients with cardiac arrest: a retrolective investigation. Support Care Cancer 2010; 18:1287-92. [PMID: 19813029 PMCID: PMC2923330 DOI: 10.1007/s00520-009-0746-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 09/15/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Today, prehospital emergency medical teams (EMTs) are confronted with emergent situations of cardiac arrest in palliative care patients. However, little is known about the out-of-hospital approach in this situation and the long-term survival rate of this specific patient type. The aim of the present investigation was to provide information about the strategic and therapeutic approach employed by EMTs in outpatient palliative care patients in cardiac arrest. METHODS During a period of 2 years, we retrolectively analysed emergency medical calls with regard to palliative care emergency situations dealing with cardiac arrest. We evaluated the numbers of patients who were resuscitated, the prevalence of an advance directive or other end-of-life protocol, the first responder on cardiac arrest, the return of spontaneous circulation (ROSC) and the survival rate. RESULTS Eighty-eight palliative care patients in cardiac arrest were analysed. In 19 patients (22%), no resuscitation was started. Paramedics and prehospital emergency physicians began resuscitation in 61 cases (69%) and in 8 cases (9%), respectively. A total of 10 patients (11%) showed a ROSC; none survived after 48 h. Advance directives were available in 43% of cases. The start of resuscitation was independent of the presence of an advance directive or other end-of-life protocol. CONCLUSIONS Strategic and therapeutic approaches in outpatient palliative care patients with cardiac arrest differ depending on medical qualification. Although many of these patients do not wish to be resuscitated, resuscitation was started independent of the presence of advance directive. To reduce legal insecurity and to avoid resuscitation and a possible lengthening of the dying process, advance directives and/or "Do not attempt resuscitation" orders should be more readily available and should be adhered to more closely.
Collapse
Affiliation(s)
- Christoph H R Wiese
- Department of Anaesthesiology, University of Regensburg, Regensburg, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Wiese C, Löffler E, Vormelker J, Meyer N, Taghavi M, Strumpf M, Kazmaier S, Roessler M, Zausig Y, Popov A, Lassen C, Graf B, Hanekop G. Kenntnisse angehender Notfallmediziner über die Tumorschmerztherapie bei Palliativpatienten. Schmerz 2010; 24:508-16. [DOI: 10.1007/s00482-010-0956-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
Notärztliche Behandlung akuter Schmerzexazerbationen bei ambulanten Palliativpatienten in Deutschland. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1317-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
[Emergency medical treatment of palliative care patients at the end of life: regulatory emergency medical care framework--a case control investigation of medical intervention and advance directives]. Anaesthesist 2010; 58:1097-106. [PMID: 19890614 DOI: 10.1007/s00101-009-1627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The treatment of out-of-hospital palliative emergency care situations during cardiac arrest is a special situation. The prehospital emergency physician (EP) and the paramedic must be informed about the medical, legal, and ethical specifics of these situations, but this knowledge is not integrated within emergency medical curricula at all. We present a case study to discuss such legal and ethical specifics. METHODS We retrospectively analysed six emergency cases with palliative care patients in the final stages of their illnesses. On the basis of these case studies, we present six different emergency cases with different regulatory frameworks for each EP and paramedic. In accordance with the Declaration of Helsinki, data were collected pseudonymously. RESULTS The six case studies show therapeutic concepts concerning the emergency medical care of palliative care patients during cardiac arrest. The differences are apparent in the treatment given by EPs and by paramedics (such as whether to start or stop resuscitation). EPs and paramedics differ in their therapeutic approach to these specific situations (e.g. paramedics more often start resuscitation during cardiac arrest even though patients would refuse this according to their advance directives). These differences may be important for the patient and his or her caregivers. CONCLUSIONS Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation.
Collapse
|
38
|
Ambulante und stationäre palliativmedizinische Patientenversorgung in Deutschland. Anaesthesist 2010; 59:162-70. [DOI: 10.1007/s00101-009-1651-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|