Research On The Current Status And Effect Of Clinical Practice Of Emergency Palliative Car

BackgroundEmergency medicine has been facing to the challenges from increasing burden of end-of-life patients and elder patients visiting,in the past decades.The changes force emergency departments providing palliative care under these conditions.Palliative care is management by delivering symptoms control,social and psychologic support,spiritual care,improving patients and care givers quality of life among the end-of-life stage.World Health Organization suggested to implement palliative care with multiple models,and charactered two levels of patients care,one is primary palliative care could be conducted by all kinds of specialties and the other one is the one which could be implemented by well-trained palliative care specialists.Integration of palliative care into emergency medicine could be identified as one of the primary palliative care.With literature reviews,it has been proved that palliative care would improve quality of end-of-life patient,with lower rate of life sustain management incidence.Since 2018,palliative care has been introduced into emergency department,the precise perception among emergency clinicians and nurses could determine quality of patients care.Chinese emergency medicine is at the early stage of seeking for a modality of integrating palliative care with medical service,as the comprehensive hospital,the role is to identify patients needs and initially providing primary palliative care,with the medical transfer to consortium,competency of palliative care among staffs from consortium is another item for quality of patients.ObjectiveThe study analyzed primary palliative care perception and implementation among Chinese emergency clinicians and nurses,which included participants selfevaluation,previous learning experience,confidence of clinical care,attitudes about death,primary palliative care clinical decisions and eagerness of further education.Then,this study explained the perception and implementation on palliative care of faculties from consortium,and analyzed the effect on training modalities,developed training design for further education.The last not the least,this study explored the prognosis of patients who accepted emergency palliative care,explained the impact on the clinical outcome,compared with conventional group,then interpreted the advantage for implementation it.MethodsThe first session of this study was a cross-sectional study,with an online questionnaire,it demonstrated the self-evaluation,previous training experience,confidence of providing primary palliative care,attitudes about death,the clinical decision of patients care among Chinese emergency clinicians and nurses.The second session was a cross-sectional study located in an emergency medical consortium,with the questionnaire,revealed the condition of previous training experience among faculties of this hospital,and analyzed the effect of the training enhanced the perception and implementation of palliative care.The third session is a cohort study recruited patients by propensity score matching,established a conventional group to compare the clinical outcomes and implementation of palliative care among these referral patients.。ResultsThis study reported most clinicians and nurses had no exposure to previous education in primary PC(5944[86·0%]),and high self-evaluations were reported among participants(2,876[42·1%]).Over half(3,473[50·8%])of the participants preferred early integration of primary PC into emergency patient treatment,low comfortable of addressing interventions were reported.This study has primarily revealed certain misconceptions of participants on implementing primary PC,especially the perceptions regarding symptom control management.Moreover,even with high eagerness for further education on primary PC reported in our study(5,051[73·9%]),High eagerness was aligned with previous training experience,professions,the experience of loss of families,and high self-evaluation.The second session reported 429(46.5%)faculties received PC training.Training improved the total score of knowledge and practice of PC(median 108 vs.116,P<0.001),the confidence in clinical PC management(confidence score:36 vs.40,P<0.001),and attitudes towards PC implementation(attitude score:42 vs.42,P=0.015).Offline lecture-based learning was the primary training form in this hospital.The ORs of case-based learning,online lecture video,and community training project to higher total scores were 1.94(95%CI 1.18-3.17,P=0.009),2.09(1.23-3.56,P=0.006)and 0.17(0.04-0.63,P=0.008),respectively.By the last part of research,demonstrated the population among medical consortium referral,palliative care group compared with conventional group higher mortality rate(52.7%vs 23.0%,P value<0.01),lower invasive intervention implementation and longer in-hospital stays.ConclusionTraining experience was not enough for both Chinese emergency clinicians/nurses and faculties of emergency medical consortium.High self-evaluation was reported among Chinese clinicians and nurses.This study demonstrated misconceptions between high confidence and precise implementation of primary palliative care.Among all the educational modalities,none of them was reported with improvements on palliative care,faculties demonstrated high misconception of pain management for the patients,calling for well-designed program in the future.The advantages for emergency department patients who transferred to medical consortium were unclear,call for further research with more sample size and well designed.