title: The effect of education in hospice and palliative care on emergency medicine residents' knowledge and referral patterns.
abstract: OBJECTIVE
  To determine: (1) residents' knowledge base in key concepts in hospice and palliative care, (2) residents' comfort level in discussing end-of-life (EOL) care and managing EOL symptoms, and (3) if a brief educational intervention improves residents' knowledge of and comfort in dealing with EOL issues both immediately following and six months after the intervention.
  
  
  METHODS
  This prospective cohort study was performed at a level-1 community trauma center. A survey was developed regarding knowledge of palliative care and its emergency department (ED) utilization and administered to emergency medicine (EM) residents. Subsequently, residents underwent four hours of palliative care training. An identical post-education survey was administered immediately and then six months later.
  
  
  RESULTS
  Education improved knowledge of hospice qualifying diagnoses which was maintained at six months. Improvement in residents' ability to convert between oral and intravenous formulations of opioids was not retained at six months. Education was not shown to improve EM residents' comfort in managing pain or dyspnea but it was shown to improve their comfort level in discussing EOL care with patients and families Inpatient hospice admissions from the ED increased 88% after the education. Identified barriers to providing palliative care in the ED decreased.
  
  
  CONCLUSIONS
  There are gaps in EM residents' hospice and palliative care knowledge. Education is shown to improve and maintain knowledge of hospice qualifying diagnoses, comfort level in discussing EOL care with patients and families, and to increase inpatient hospice admissions from the ED.
authors.affiliation: San Diego Hospice and the Institute for Palliative Medicine, San Diego, California, USA. tdevader@mac.com
authors.forename: Travis E
authors.initials: TE
authors.lastname: DeVader
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jeanmonod
mesh_terms: D015331:Cohort Studies; D003625:Data Collection; D004635:Emergency Medicine; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care; D006801:Humans; D007396:Internship and Residency; D010166:Palliative Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation