Emergency department staff priorities for improving palliative care provision for older people: A qualitative study

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Background:Emergency department–based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions.Aim:To collaboratively identify with emergency clinicians’ improvement priorities for emergency department–based palliative care for older people.Design:This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions.Setting/participants:In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery.Results:Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, “training and education” replaced “time constraints” as a priority.Conclusion:Clinician priorities for improving emergency department–based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients’ needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.

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