Int J Emerg Med. 2015 Apr 29;8:14. doi: 10.1186/s12245-015-0061-8. eCollection 2015.
Managing the advanced cancer patient in the Australian emergency department environment: findings from a national survey of emergency department clinicians.
International journal of emergency medicine
Tracey J Weiland, Heather Lane, George A Jelinek, Claudia H Marck, Jennifer Weil, Mark Boughey, Jennifer Philip
Affiliations
Affiliations
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy 3065 Australia ; Department of Medicine, The University of Melbourne, Parkville, 3052 Australia.
- Centre for Palliative Care, The University of Melbourne (St Vincent's Hospital), Fitzroy, 3065 Australia ; St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia.
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy 3065 Australia ; Erasmus Medical Centre, Rotterdam, The Netherlands.
- St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia.
PMID: 25984244
PMCID: PMC4424226 DOI: 10.1186/s12245-015-0061-8
Abstract
BACKGROUND: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians' attitudes to the ED environment when caring for patients who present with advanced cancer, and how these attitudes are affected by access to palliative care services, palliative care education, staff type, ED experience and patient demographic, hospital type and region.
METHODS: We electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED.
RESULTS: Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care.
CONCLUSIONS: ED environments place pressure on clinicians delivering care to people with advanced cancer. Integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered.
Keywords: Cancer; Emergency medicine; End-of-life care; Palliative care; Survey
References
- Br J Cancer. 2013 Apr 2;108(6):1273-9 - PubMed
- Emerg Med Australas. 2005 Apr;17(2):117-23 - PubMed
- J Emerg Nurs. 2006 Dec;32(6):477-85 - PubMed
- Psychiatry J. 2014;2014:943574 - PubMed
- J Neurooncol. 2014 Jan;116(1):119-26 - PubMed
- Emerg Med Australas. 2010 Oct;22(5):391-8 - PubMed
- J Emerg Nurs. 2002 Dec;28(6):515-22 - PubMed
- Clin Oncol (R Coll Radiol). 2009 Apr;21(3):226-33 - PubMed
- Ann Emerg Med. 2011 Apr;57(4):362-9 - PubMed
- BMC Med Ethics. 2013 Feb 20;14:8 - PubMed
- Emerg Med Australas. 2011 Dec;23(6):697-711 - PubMed
- Soc Sci Med. 2011 Nov;73(9):1371-7 - PubMed
- Ann Emerg Med. 2011 Mar;57(3):265-78 - PubMed
- BMJ. 1992 May 9;304(6836):1207-9 - PubMed
- Emerg Med Australas. 2013 Apr;25(2):154-60 - PubMed
- AMIA Annu Symp Proc. 2008 Nov 06;:1059 - PubMed
- Med J Aust. 2007 Dec 3-17;187(11-12):624-5 - PubMed
- J Emerg Nurs. 2012 Sep;38(5):e15-25 - PubMed
- Acad Emerg Med. 2010 Nov;17(11):1253-7 - PubMed
- CMAJ. 2010 Apr 6;182(6):563-8 - PubMed
- Intern Med J. 2014 Apr;44(4):362-8 - PubMed
- Support Care Cancer. 2011 Jul;19(7):963-9 - PubMed
- Oncol Nurs Forum. 2012 Sep;39(5):E398-406 - PubMed
- J Palliat Med. 2003 Oct;6(5):715-24 - PubMed
- Emerg Med Australas. 2006 Aug;18(4):391-7 - PubMed
- N Engl J Med. 2010 Aug 19;363(8):733-42 - PubMed
- J Clin Epidemiol. 1997 Oct;50(10):1129-36 - PubMed
- Intensive Care Med. 2004 Dec;30(12):2143-4 - PubMed
- J Emerg Nurs. 2012 Sep;38(5):e7-14 - PubMed
- Emerg Med Clin North Am. 2009 May;27(2):341-54 - PubMed
- J Am Geriatr Soc. 2007 Jul;55(7):993-1000 - PubMed
- J Emerg Med. 2003 Oct;25(3):329-33 - PubMed
- Emerg Med Int. 2012;2012:486516 - PubMed
- Intensive Care Med. 2010 May;36(5):765-72 - PubMed
- Emerg Med Australas. 2010 Apr;22(2):119-35 - PubMed
- HERD. 2012 Spring;5(3):26-45 - PubMed
- J Emerg Med. 2012 Nov;43(5):803-10 - PubMed
- J Emerg Nurs. 2008 Aug;34(4):290-300 - PubMed
- Crit Care. 2011;15(2):216 - PubMed
- Age Ageing. 2011 Mar;40(2):233-8 - PubMed
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