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

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 semistructured interviews and feedback sessions. Setting/participants: In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital ED 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. Conclusions: 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 if priorities are shared across other EDs, and develop, implement and evaluate strategies developed by clinicians.