Building Confidence in End-of-Life Decision-Making in the Emergency Department
By Dr Jayne Hewitt, Senior Lecturer in the School of Nursing and Midwifery at Griffith University
The Emergency Department (ED) is a fast-paced environment where complex decisions must be made quickly.
Most commonly, these decisions are directed toward improving, restoring or sustaining health and function.
For some patients, these goals are no longer appropriate. Where serious or irreversible illness is recognised, and deterioration accelerates, decisions about transitioning to end-of-life care must be made.
Navigating these situations requires ED clinicians to make and enact decisions that are clinically appropriate, meet patient goals, and comply with the law.
In our recent research published in Australian Critical Care we explored how emergency and critical care clinicians understand and apply the law in end-of-life decision-making.
What we heard was consistent and compelling. Clinicians want to provide care that aligns with patient values and legal requirements, but many feel underprepared to do so, especially in the frenetic and unpredictable environment of the ED. Encounters with patients that present with life limiting illness, advanced frailty, or sudden deterioration, create critical opportunities for end-of-life conversations and advance care planning.
However, without the right training these opportunities can be missed. Time pressure, lack of confidence, uncertainty about legal obligations, and discomfort initiating sensitive conversations all contribute to hesitation and delay.
Many participants in our study described positive attitudes towards end-of-life care but reported having limited access to practical education that reflects the realities of emergency practice.
Communication skills, recognising when a patient may be approaching end of life, and understanding how advance care directives apply in emergency settings were commonly identified gaps.
Education is a powerful enabler of change. Creative approaches to improving knowledge and understanding around this complex area are needed to ensure clinicians have the confidence to initiate end-of-life conversations, and support families to make compassionate, patient-centred decisions, in accordance with the law.
If we are serious about delivering patient centred care, then end-of-life education must be seen as core business in the ED.
By investing in education, we not only support our workforce but also ensure that patients and families receive care that respects their values at one of the most vulnerable moments of their lives.
Learn more in the updated End-of-Life Essentials Emergency Department End-of-Life Care module which helps staff build confidence in end-of-life conversations and goals-of-care in the fast-paced ED setting.
Dr Jayne Hewitt, Griffith University.