title: Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers.
abstract: BACKGROUND
  Despite increased focus on improving palliative care in the emergency department (ED), there is little research on how to best address the specific needs of this patient population.
  
  
  OBJECTIVE
  To better understand the experiences of acutely symptomatic patients seen in the ED.
  
  
  METHODS
  Using in-person semi-structured interviews, we explored the attitudes, experiences, and beliefs of 14 patients and seven family caregivers on the inpatient palliative care consult service, who had been admitted through the ED at two academic medical centers. We used a grounded theory approach to code responses. Transcripts were coded by a palliative medicine physician, an emergency medicine physician, and a general internist. Discrepancies were resolved by consensus. Coded sections were iteratively reviewed for interpretation, and concepts were collapsed into themes.
  
  
  RESULTS
  Five distinct themes emerged: 1) unprepared for managing symptoms at home; 2) uncertainty and anxiety; 3) communication is essential; 4) mixed experiences with symptom management; and 5) conflicting perspectives about the purpose of palliative care clinicians in the ED.
  
  
  CONCLUSIONS
  Patients and caregivers identified systems, communication, and clinical issues in ED care that should be a focus for future research.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA 94121, USA. aksmith@ucsf.edu
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.forename: Mara A
authors.initials: MA
authors.lastname: Schonberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fisher
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
authors.forename: Lachlan
authors.initials: L
authors.lastname: Forrow
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003142:Communication; D003625:Data Collection; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010361:Patients; D013727:Terminal Care; D055815:Young Adult