Understanding emergency department staff needs and perceptions in the provision of palliative care.
OBJECTIVE
The primary aim of the present study was to investigate Australian ED staff perspectives and needs regarding palliative care provision. Secondary aims were to assess staff views about death and dying, and their awareness of common causes of death in Australia, particularly those where a palliative care approach is appropriate.


METHODS
All medical and nursing staff working in a private ED in Perth, Western Australia, were asked to complete a combined quantitative and qualitative survey. The survey tool uses a combination of Likert-type scales and open-ended questions. Descriptive statistics and intergroup comparisons were made for all quantifiable variables, whereas formal content analysis was used for text responses.


RESULTS
Surveys were returned by 22 doctors and 44 nurses, with most reporting only working knowledge of palliative care but clinical proficiency in symptom control. Confidence in palliative care provision was lower among nursing than medical staff but educational needs were similar. Cancer diagnoses were consistently overestimated, and dementia and COPD underestimated, as the most common causes of death. Only six of 63 (9.5%) of respondents identified the correct top five causes of death.


CONCLUSIONS
Our study suggests that although ED staff expressed confidence regarding symptom management in palliative care, they lacked understanding of the patients in whom a palliative approach could be applied and sought further education in areas, such as end-of-life communication and ethical issues. ED specific training and clinical interventions in palliative care provision would seem to be needed and justified.
Emergency Department, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia.
Freya M
FM
Shearer
Ian R
IR
Rogers
Leanne
L
Monterosso
Gail
G
Ross-Adjie
Jeremy R
JR
Rogers
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002983:Clinical Competence / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000592:standards*; D020377:Self Efficacy; D014904:Western Australia
cause of death; emergency medicine; end of life; palliative care