Palliative care

Abstract

Patients with a malignancy often seek care in the emergency department (ED) for relief of distressing symptoms and for oncologic and other crises. These ED visits increase as patient health declines. The ED also frequently sets the stage for future healthcare, including initiation of life-prolonging interventions or connecting a patient to palliative care (PC) resources. The PC approach is holistic, promotes quality of life considerations, and includes the "whole" person to not only manage the patient's physical symptoms but also address their psycho-social, emotional, and spiritual needs. Optimal care of the seriously ill patient with cancer therefore involves early integration of palliative care into the ED. Majority of palliative care in the ED such as symptom management and advance care planning is provided by the emergency clinician at a "generalist" level. For difficult to control symptoms or complex decision-making, the ED will likely need added support from a trained expert in palliative medicine to provide "specialist" level palliative care. Building capacity for ED palliative care therefore includes both advancing the skill set of the generalist ED clinicians and identifying opportunities to partner with specialists to integrate early palliative care into ED practice. In this chapter we describe ways to build capacity for palliative care provision into eligible patients suffering from cancer in the ED. This includes identifying key champions, gathering an inventory of resources, conducting a needs assessment, and establishing metrics that allow for measurement of impact and outcomes.