Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda
Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda
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DOI：
10.1111/acem.13083
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发表时间：
2016-12-01
影响因子：
4.4
通讯作者：
Platts-Mills, Timothy F.
中科院分区：
文献类型：
--
作者：
George, Naomi R.;Kryworuchko, Jennifer;Platts-Mills, Timothy F.
背景关于共享决策(SDM)在急诊科(ED)指导临终和临终决策的最佳使用方法知之甚少。目标是召集一个工作组来开发一组研究问题，一旦得到回答，将极大地提高临床医生使用SDM来指导急诊科临终和临终决策的能力。方法根据急诊、姑息或老年病护理、政策或患者倡导以及跨医生、护理、社会工作、法律和患者视角确定参与者。小组的意见是通过时间交错的Delphi过程获得的，包括三个电话会议，一个用于异步输入的开放平台，以及一个面对面的会议，以获得所有成员的最后一轮意见，并确定和解决或描述分歧的领域。结论小组确定的关键研究问题与ED患者可能从姑息治疗(PC)中受益有关，哪些干预措施可以最有效地在ED中促进PC，什么结果最适合评估这些干预措施的影响，在ED中启动提前护理计划以帮助患者确定长期护理目标的潜力是什么，以及哪些政策会影响急诊科的姑息和临终关怀决策。对这些问题的回答有可能极大地提高对患有晚期疾病的ED患者的护理质量。(C)学术急救医学学会2016年
BackgroundLittle is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED).ObjectiveThe objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED.MethodsParticipants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement.ConclusionKey research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness. (C) 2016 by the Society for Academic Emergency Medicine