Emergency department staff priorities for improving palliative care provision for older people: A qualitative study

Rebecca Wright, Karen Lowton, Glenn Robert, Corita R. Grudzen, Patricia Grocott

Research output: Contribution to journalArticle

Abstract

Background: Emergency department–based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions. Aim: To collaboratively identify with emergency clinicians’ improvement priorities for emergency department–based palliative care for older people. Design: This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions. Setting/participants: In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery. Results: Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, “training and education” replaced “time constraints” as a priority. Conclusion: Clinician priorities for improving emergency department–based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients’ needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.

Original languageEnglish (US)
Pages (from-to)417-425
Number of pages9
JournalPalliative Medicine
Volume32
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Palliative Care
Hospital Emergency Service
Emergencies
Interviews
Communication
Nurse Clinicians
Education
Access to Information
Quality of Health Care
Hospital Departments
Research
Teaching Hospitals
Uncertainty

Keywords

  • emergency department
  • frail older adults
  • Palliative care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Emergency department staff priorities for improving palliative care provision for older people : A qualitative study. / Wright, Rebecca; Lowton, Karen; Robert, Glenn; Grudzen, Corita R.; Grocott, Patricia.

In: Palliative Medicine, Vol. 32, No. 2, 01.02.2018, p. 417-425.

Research output: Contribution to journalArticle

Wright, Rebecca ; Lowton, Karen ; Robert, Glenn ; Grudzen, Corita R. ; Grocott, Patricia. / Emergency department staff priorities for improving palliative care provision for older people : A qualitative study. In: Palliative Medicine. 2018 ; Vol. 32, No. 2. pp. 417-425.
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