Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda.
Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED).



The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED.



Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement.



Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.
Department of Emergency Medicine, Brown University, Providence, RI.
Naomi R
NR
George
University of British Columbia, Vancouver, British Columbia, Canada.
Jennifer
J
Kryworuchko
University of Virginia, Charlottesville, VA.
Katherine M
KM
Hunold
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
Kei
K
Ouchi
Hartford Program Officer/Patient Representative, New York, NY.
Amy
A
Berman
Department of Emergency Medicine, NYU School of Medicine, New York, NY.
Rebecca
R
Wright
Department of Emergency Medicine, NYU School of Medicine, New York, NY.
Corita R
CR
Grudzen
Department of Emergency Medicine, Yale University, New Haven, CT.
Olga
O
Kovalerchik
Department of Emergency Medicine, Geriatric Fellow, University of North Carolina-Chapel Hill, Chapel Hill, NC.
Eric M
EM
LeFebvre
Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
Rachel A
RA
Lindor
Department of Emergency Medicine, Emory University, Atlanta, GA.
Tammie E
TE
Quest
Departments of Emergency Medicine and Hematology/Oncology, Oregon Health and Science University, Portland, OR.
Terri A
TA
Schmidt
School of Social Work, McGill University, Montreal, Quebec, Canada.
Tamara
T
Sussman
National POLST Paradigm, Portland, OR.
Amy
A
Vandenbroucke
Section of General Medicine, Harvard Medical School, Boston, MA.
Angelo E
AE
Volandes
Department of Emergency Medicine and Department of Anesthesiology, University of North Carolina-Chapel Hill, Chapel Hill, NC.
Timothy F
TF
Platts-Mills
D032722:Advance Care Planning; D032921:Consensus; D003657:Decision Making; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning; D057766:Policy; D013727:Terminal Care / Q000458:organization & administration*