International concepts related to prehospital emergency treatment in terminally ill patients a prospective questionnaire-based study

Transcription

1 International concepts related to prehospital emergency treatment in terminally ill patients a prospective questionnaire-based study EAPC Research Congress Glasgow, Scotland Department of Anaesthesiology (Prof. Dr. B. M. Graf, MSc.) University of Regensburg, Germany

2 Table of contents Background Aim of the study Methods Results Limitations Conclusions

3 Background Specialised outpatient Palliative Care Systems (SPCS) are important structures regarding the out-of-hospital treatment of palliative care emergencies. In Germany, the base-level financing of existing out-of-hospital Palliative Care Teams (PCT) is only partially guaranteed. Therefore, other medical care systems have to be implemented for the medical treatment of out-of-hospital palliative care emergency situations (e.g. prehospital emergency medical systems).

4 Background The incidence of palliatively motivated emergency medical requests is about 3-10% of all emergency medical care situations.* *Tsai SC et al. (2010) Support Care Cancer, Smith AK et al. (2009) Ann Emerg Med, Wiese et al. (2009) Support Care Cancer This suggests that, theoretically, every prehospital emergency physician (EP) will be confronted with a need to provide medical care for palliative patients. The aim of emergency medical care is to preserve life. Therefore, EPs often appreciate the wishes of palliative patients incorrectly.** **Savory EA and Marco CA (2010) Scand Trauma Resusc Emerg Med

5 Aim of the study The aim of our investigation was to evaluate international concepts concerning prehospital emergency medical care in terminally ill patients as well as in palliative patients.

6 Methods (1) A literature search was performed using the Cochrane database of systematic reviews, EMBASE, PubMed, and Medline for the years 1990 to (2) We used the following free text search terms: palliative medicine and emergency medicine, palliative emergency, end of life decision, resuscitation and palliative care, palliative care and prehospital emergency medicine.

7 Methods (3) The literature search was limitated to English literature. (4) The search and the review of the databases was independently performed by three reviewers. (5) The reviewers enclosed randomized controlled trials, observational studies, reviews, meta-analysis, case series, and case controlled studies. (6) All together 100 international experts were selected by literature analysis.

8 Methods (7) The literature search proved an overweight of West-European, American and Canadian experts. (8) Therefore, 50 experts of national associations for palliative care all over the world were also invited to take part in the investigation. (9) Data were collected for five types of information: (1) demographic data, (2) in-hospital palliative care structures, (3) out-of-hospital palliative care structures, (4) concepts in outpatient palliative emergency medical care, (5) advance directives.

9 Methods - Questionnaire

10 Results Survey responses were obtained from 92 experts (response rate 61%). Survey responses were obtained from 35 different countries (Europe 22x, North America 2x, South America 3x, Asia 3x, Africa 3x, and Australia). By the investigated participants, the incidence of palliatively motivated emergency medical situations request about 5% of all prehospital emergencies as palliatively motivated (29%, n=27), 10% of all prehospital emergencies as palliatively motivated (44%, n=40), >10% of all prehospital emergencies as palliatively motivated (14%, n=13).

11 Results To reduce emergency medical care contacts in palliative patients, the following standards were mentioned as existing: 1) Emergency medical documents (60%). 2) End-of-life discussions (43%). 3) Collaboration (palliative and emergency physicians, 2%). 4) Integration of palliative care into emergency medical structures and curricula (each 2%).

12 Results To improve the emergency medical care of palliative patients, the following standards were mentioned as necessary: 1) Advance care planning (e.g advance directives, emergency medical documents). 2) Education and training of prehospital emergency medical teams in basic Palliative Care skills (e.g. symptom control, ethical and legal issues, goals of care, family witnessed resuscitation, comprehensive care in the last hours of living). 3) Collaboration between palliative care and emergency medical care systems.

13 Results To improve the emergency medical care of palliative patients, the following standards were mentioned as necessary: 4) Indicators for the need of palliative care in the prehospital emergency treatment (e.g. aspects of the dying patient). 5) End-of-life care models.

14 Limitations of the study 1) We used a self-administered survey. 2) The literature search was limitated to English literature. 3) Because participation was voluntary, participants may represent those who have strong opinions about the issues or may represent those with more time available to participate in the survey. 4) The existing standards have not been evaluated clinically. 5) Further studies based on clinically experiences are necessary.

15 Conclusions In summary, our investigation was able to detect outpatient palliative care approaches, which are structurally different. These should be discussed accordingly and be adapted to the respective specificities of the single countries. Single established outpatient palliative emergency medical care concepts may build the basis for national ones.

16 Conclusions The Education in Palliative and End-of-life Care for Emergency Medicine project (EPEC-EM) may be considered as one potential source for evidence based content in palliative and emergency medical care.* *Emanuel LL, Quest T (2008) (accessed Jan 14, 2010) However, we should always respect the dying patient's needs for care, comfort, and compassion.** **Marco CA, Savory EA (2009) Scand J Trauma Resusc Emerg Med 17:21

17 Acknowledgements The authors express their gratitude to all participants for their excellent support.

18 THANK YOU FOR YOUR ATTENTION