Abstract 1519P
Background
Any attempts at understanding the reasons underlying the paucity of coordination between Emergency and palliative services needs to study practices prevailing in the emergency more closely.
Methods
A questionnaire containing queries related to decision making pertaining the acute care management of a metastatic triple negative breast cancer patient presenting with altered sensorium and noisy breathing, whose primary caregiver has agreed in principle, to forego invasive life prolonging modalities of treatment and indications for a palliative medicine liaison in the emergency setting was distributed among residents, trainees and faculty of the Emergency medicine department.
Results
16/17 respondents agreed that the correct time to obtain a Palliative medicine liaison would be following intubation and mechanical ventilation with an aim to seek further clarity on the goals of care. 4/17 agreed that the correct setting for a review would be the yellow area, once the patient has been downtriaged. 14/17 agreed that they would counsel the family members regarding the need for an imminent admission to intensive care. 5/15 agreed that they would seek a palliative medicine liaision, only after a CT scan of the neuraxis had been performed. 16/17 would counsel the relatives about the Medical orders for life sustaining treatment paradigm at the time of downtriage. Management of Malignant bowel obstruction in stage four platinum resistant ovarian cancer (16/17), intravenous morphine infusion in cancer pain (12/17), management of altered sensorium in squamous cell carcinoma patient presenting with headache and polyuria (6/17), management of recent onset paraparesis in multiple myeloma (5/16) and intravenous morphine infusion in non cancer pain (3/16) were ranked, in this order of priority, as indications for a Palliative medicine liaison in the emergency.
Conclusions
The results point towards a hesistancy in seeking review for management of medical issues in advanced cancer. A Palliative medicine liaison is being considered after most acute care options have been exhausted.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Rahul D. Arora.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.