Palliative Care and the Emergency Physician

Palliative care is defined by the WHO as “An approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.” As clinicians who practice at a portal of entry for healthcare, are we the ones best positioned to initiate palliative care discussions or should we defer to the in-patient teams and palliative care experts? An editorial from two EM clinicians from Wake Forest states: “This is our place to act. These are our patients. Making important treatment options more accessible from the front door of the hospital is what we do. Downstream effects of ED-initiated interventions cannot be ignored.” In the ED, we bear witness on a daily basis to patients who receive futile interventions and in many cases harms associated with those interventions. What role can we play in communicating and initiating a discussion about palliative care to our patients and their families? How might we teach those new to EM how to help patients define their goals of care in the setting of the ED? The Model of the Clinical Practice of Emergency Medicine lead authored by our own Dr. Counselman includes palliative care as a requirement for training. How do we best teach others to acquire the skills to lead those discussions with their patients. I am hopeful that we will have another big community faculty turnout as this is one of those topics where personal experience is likely to provide the most useful insights. In addition to the articles being presented, I included a few essays of interest one of which was published by my own son as a student some years ago. 


Wang DH et al, Beyond Code Status: Palliative Care Begins in the Emergency Department. Ann Emerg Med. 2017 Jan 25.

 George NR et al, Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda. Acad Emerg Med. 2016 Dec;23(12):1394-1402.

 Grudzen CR et al. Emergency Department-Initiated Palliative Care in Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol. 2016 Jan 14.

Graffeo C. The Goals of Care Acad Emerg Med 20 (9) September 2013

Siegel M. Palliative Care as Life Support for My Career. J Emerg Med. 2017 Jan 121-2

Lamas D, Freedom from the tyranny of choice--teaching the end-of-life conversation. N Engl J Med. 2012 May 3;366(18):1655-7