Palliative care in emergency services: an integrative review

Medeiros, Maria Olívia Sobral Fraga de; Meira, Mariana do Valle; Santos, Jacilene Santiago do Nascimento Trindade dos; Pedreira, Larissa Chaves; Fonseca, Anelise Coelho da; Silva, Rudval Souza da

doi:10.1590/1983-80422021292479

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Research • Rev. Bioét. 29 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1983-80422021292479 copy

Palliative care in emergency services: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article seeks to understand the approach of emergency teams to patients with an advanced chronic condition from a palliative care perspective. This integrative review searched for articles in five databases using the descriptors “emergency medical services,” “patient assistance team,” “attitudes of health personnel” and “palliative care”. At first, 12,290 publications were identified, which were then reduced to 26 articles for the final sample. Among the main measures found in the literature to use palliative care in emergency services, the following stand out: individualized and flexible care plan; network management; access to the palliative care team; empathic communication; identification eligible patients; and control of symptoms. We thus conclude that emergency teams must recognize the importance of palliative care and redirect the care focused in “saving lives” towards a care that preserves human dignity.

Patient care team; Emergency service, hospital; Palliative care

Base, journal, year, country	Objective	Team approach
Medline, J Palliat Med, 2013, USA ³	Discover barriers perceived by doctors when providing palliative care in the emergency department.	– Identification of eligible patients. – Access to the palliative care team.
Medline, West J Emerg Med, 2013, USA ⁵	Describe the approach and the role of the emergency team regarding palliative and end-of-life care.	– Identification of eligible patients. – Access to the palliative care team. – Care network management. – Interdisciplinary team performance. – Emergency team professional as a reference in palliative care. – Individualized and flexible care plan. – Differentiation between palliative care and end-of-life care.
Cinahl, J Palliat Med, 2013, USA ⁶	Evaluate whether interconsultations with palliative care teams initiated in the emergency department reduce the inpatient length of stay, compared to interconsultations initiated after hospital admission.	– Identification of eligible patients. – Access to the palliative care team. – Care network management. – Interdisciplinary team performance.
Cinahl, Ann Emerg Med, 2013, USA ⁷	Identify administrative factors that interfere with the availability and provision of palliative care in the emergency department	– Care network management. – Individualized and flexible care plan. – Support to the family.
Cinahl, Am J Hosp Palliat Care, 2013, Ireland ⁸	Identify palliative care patients assisted in the emergency department	– Identification of eligible patients. – Access to the palliative care team. – Empathic communication.
Medline, J Palliat Med, 2014, USA ⁹	Evaluate the effectiveness of a multimodal intervention strategy to improve end-of-life care in the emergency department.	– Empathic communication. – Control of symptoms. – Differentiation between palliative care and end-of-life care. – Minimization of futile treatments. – Adoption of advance directives (living will). – Individualized and flexible care plan.
Medline, Asian Pac J Cancer Prev, 2014, Turkey ¹⁰	Identify characteristics of patients with cancer diagnosis admitted to the emergency department.	– Control of symptoms. – Care network management. – Integration with home care.
Medline, Support Care Cancer, 2014, Australia ¹¹	Explore views and experiences of interdisciplinary interaction of health professionals who care for patients with advanced cancer attended in the emergency department.	– Empathic communication. – Individualized and flexible care plan. – Care network management. – Integration with home care. – Interdisciplinary team performance.
Medline, Emerg Med Australas, 2014, Australia ¹²	Investigate the perspectives and needs of an emergency team in relation to palliative care.	– Control of symptoms. – Empathic communication. – Individualized and flexible care plan.
Medline, Intern Med J, 2014, Australia ¹³	Evaluate barriers and enablers in relation to end-of-life care for cancer patients attended in the emergency department.	– Individualized and flexible care plan. – Minimization of futile treatments. – Adoption of advance directives (living will).
Medline, J Palliat Med, 2014, USA ¹⁴	Identify the rate of interconsultation with the palliative care team in the emergency department for patients with advanced dementia.	– Identification of eligible patients. – Access to the palliative care team.
Medline, Acad Emerg Med, 2014, USA ¹⁵	Evaluate the early referral of patients with advanced cancer from the emergency department to the palliative care unit.	– Identification of eligible patients. – Access to the palliative care team.
Medline, Palliat Med, 2015, Australia ¹⁶	Explore the understanding of palliative care by health professionals who care for patients with advanced cancer in an emergency department.	– Control of symptoms. – Identification of eligible patients. – Empathic communication. – Discussion about ethical dilemmas.
Medline, Int J Intern Emerg Med, 2015, Australia ¹⁷	Discuss the attitudes of emergency physicians regarding the care for patients with advanced cancer, thinking about how their attitudes affect access to the palliative care service.	– Identification of eligible patients. – Access to the palliative care team. – Care network management.
Medline, Emerg Med Australas, 2015, Australia ¹⁸	Investigate the experiences and attitudes of the emergency team of a public hospital when approaching palliative care.	– Control of symptoms. – Support to the family. – Empathic communication. – Adoption of advance directives (living will).
Medline, Ann Emerg Med, 2016, France ¹⁹	Explore physicians’ perceptions and attitudes when making decisions about the transfer of critically ill elderly patients from the emergency department to the ICU.	– Identification of eligible patients. – Empathic communication. – Adoption of advance directives (living will). – Discussion about ethical dilemmas.
Medline, Int Nurs Rev, 2016, Thailand ²⁰	Describe the meaning of experiences lived by nurses when caring for critically ill patients in the emergency department.	– Individualized and flexible care plan. – Minimization of futile treatments. – Empathic communication. – Support to the family. – Support in the family’s mourning process. – Psychological and spiritual care.
Medline, J Emerg Nurs, 2016, Spain ²¹	Describe the experiences of physicians and nurses in relation to the loss of dignity of a person in end-of-life care attended in an emergency department.	– Control of symptoms. – Care network management. – Individualized and flexible care plan. – Minimization of futile treatments. – Adoption of advance directives (living will). – Support to the family. – Support to the team. – Preservation of the patient’s dignity.
Medline, J Emerg Nurs, 2016, USA ²²	Implement a best practice model to care for dying patients.	– Identification of eligible patients. – Access to the palliative care team. – Presence of the specialist nurse. – Detailed discussion among the interdisciplinary team.
Medline, BMJ Open, 2016, England ²³	Understand the decision-making process of people with advanced cancer and their caregivers when seeking emergency care.	– Interdisciplinary team performance. – Control of symptoms.
Cinahl, J Pain Symptom Manage, 2017, England ²⁴	Explore physicians’ attitudes towards intubation of terminally ill cancer patients.	– Access to the palliative care team. – Individualized and flexible care plan. – Minimization of futile treatments.
Medline, BMJ Support Palliat Care, 2017, Australia ²⁵	Explore the perspective of emergency physicians on their skills, role and experience in caring for people with advanced cancer.	– Control of symptoms. – Care network management.
Medline, Am J Hosp Palliat Care, 2017, England ²⁶	Explore the reasons why patients in need of palliative care go to the emergency department.	– Control of symptoms. – Care network management.
Medline, Age Ageing, 2017, England, Ireland and USA ²⁷	Identify barriers and enablers for the empowerment of older people with advanced disease and the impact of palliative care.	– Specialized team. – Empathic communication. – Individualized and flexible care plan. – Access to the palliative care team.
Medline, Palliat Med, 2018, Australia ²⁸	Explore experiences and perceptions of patients with advanced cancer and caregivers who seek emergency services.	– Control of symptoms. – Empathic communication. – Care network management. – Individualized and flexible care plan.
Medline, Support Care Cancer, 2018, England ²⁹	Explore opinions and experiences of emergency department patients subsequently hospitalized.	– Control of symptoms. – Empathic communication. – Care network management. – Individualized and flexible care plan.

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[1] Correspondence Rudval Souza da Silva – Universidade do Estado da Bahia. Colegiado de Enfermagem. Campus VII. Rodovia Lomanto Júnior, BR 407, km 127 CEP 48970-000. Senhor do Bonfim/BA, Brasil.