Evaluation of the readiness of the Emergency medicine physicians in recognizing the palliative needs of a patient presenting to acute care is an important first step in identifying challenges that have prevented closer integration. Acute care represents a unique environment where differences in responses to scenarios presented during a survey and choices made during actual practice (in real-world setting) have the maximum potential to impact patient outcomes.
This survey was carried out during the first of a series of three-month-long postings in Emergency as part of Senior Resident training. A questionnaire highlighting clinical and administrative issues experienced was distributed among residents and faculty during the academic program.
The following indications were recognized as legitimate indications for a palliative medicine consult by more than half of the respondents - Prognostication regarding goals of care (16/17), multimodality pain management (15/17), refractory dyspnea in metastatic breast cancer (14/17), analgesic titration (11/17), collusion (10/17) and malignant biliary obstruction (9/17). While 8/17 agreed that they would seek a review for chronic constipation in amyotrophic lateral sclerosis, 6/17 would do the same for spasticity-associated pain in multiple sclerosis. Paraneoplastic SIADH/Cerebral salt wasting syndrome and febrile neutropenia in pediatric acute leukemia were considered suitable indications for seeking liaison by 4/17 and 3/17 respondents respectively.
While the agreement with the conventional understanding of the role of a Palliative consult is along expected lines, reasons underlying the lack of willingness to consider a review for non-cancer conditions and pediatric issues need to be explored further. The timing and indication for a Palliative medicine consult at the time of initial triage are issues that have not been discussed in existent guidelines. An early consultation that involves input on medical management needs to be differentiated from early palliative care (assessment of needs at baseline and subsequent follow-up).
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
The author has declared no conflicts of interest.