Care conundrum in the emergency department: The gap between clinician awareness and patient expectations surrounding advance directives

IF 1.9 4区医学 Q3 HEALTH POLICY & SERVICES

International Journal of Health Planning and Management Pub Date : 2024-08-06 DOI:10.1002/hpm.3833

Rita A. Manfredi, Jessica Riley, Beverly Lunsford

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引用次数: 0

Abstract

Objectives

Clinicians in the emergency department (ED) frequently encounter seriously ill patients at a time when advance directives may be pivotal in improved clinician decision-making. The objectives of this study were to identify the prevalence of advanced directives in ED patients, as well as patterns of advance care discussions between patients and providers. This study describes patients' perceptions and expectations of such serious illness discussions in an emergency care setting with the expectation of including patients as strategic members of the care team.

Methods

Trained research assistants in two emergency departments surveyed patients over age 65, or their caregivers, from July 2016 to August 2018. Patients were verbally administered a standard survey tool related to advance directives and advance care planning.

Results

497 out of 877 patients completed surveys (59.4%). 50% of patients reported having an advance care planning document. The large majority (92%) of patients with an advance directive had not been asked about it during their ED visit. When questioned about their personal preferences, 79% of patients thought emergency physicians should be aware of their wishes regarding life-sustaining treatments and end-of-life care. Paradoxically, only 38% expressed a desire to discuss advance care plans with an ED clinician.

Conclusions

Older patients expect emergency clinicians to be aware of their care preferences, yet most are not asked about these care preferences in the ED. The large gap between patient preference and reality suggests the need for more targeted discussion by ED clinicians and translation of patient perspectives into system healthcare improvements. Future studies should explore barriers to advance care planning in the ED as well as patient preferences for these conversations to support a true healthcare learning system.

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急诊科的护理难题：临床医生对预先医疗指示的认识与患者期望之间的差距。

目的：急诊科（ED）的临床医生经常会遇到重病患者，而此时预先医疗指示可能会对改善临床医生的决策起到关键作用。本研究的目的是确定急诊科病人中预先医疗指示的普遍程度，以及病人和医疗服务提供者之间预先医疗讨论的模式。本研究描述了患者对急诊护理环境中此类重病讨论的看法和期望，期望将患者作为护理团队的战略成员：2016 年 7 月至 2018 年 8 月期间，两个急诊科经过培训的研究助理对 65 岁以上的患者或其护理人员进行了调查。患者口头接受了与预先指示和预先护理规划相关的标准调查工具：877 名患者中有 497 人完成了调查（占 59.4%）。50%的患者表示拥有预先护理规划文件。绝大多数（92%）有预先医疗指示的患者在急诊室就诊时并未被问及此事。当被问及个人偏好时，79% 的患者认为急诊医生应该了解他们在维持生命治疗和临终关怀方面的意愿。奇怪的是，只有 38% 的患者表示希望与急诊科医生讨论预先护理计划：结论：老年患者希望急诊医生了解他们的护理偏好，但大多数患者在急诊室并没有被问及这些护理偏好。患者的偏好与现实之间的巨大差距表明，急诊科临床医生需要进行更有针对性的讨论，并将患者的观点转化为系统的医疗保健改进措施。未来的研究应探讨急诊室预先护理计划的障碍以及患者对这些对话的偏好，以支持真正的医疗保健学习系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Health Planning and Management Multiple-

CiteScore

4.50

自引率

3.70%

发文量

197

期刊介绍： Policy making and implementation, planning and management are widely recognized as central to effective health systems and services and to better health. Globalization, and the economic circumstances facing groups of countries worldwide, meanwhile present a great challenge for health planning and management. The aim of this quarterly journal is to offer a forum for publications which direct attention to major issues in health policy, planning and management. The intention is to maintain a balance between theory and practice, from a variety of disciplines, fields and perspectives. The Journal is explicitly international and multidisciplinary in scope and appeal: articles about policy, planning and management in countries at various stages of political, social, cultural and economic development are welcomed, as are those directed at the different levels (national, regional, local) of the health sector. Manuscripts are invited from a spectrum of different disciplines e.g., (the social sciences, management and medicine) as long as they advance our knowledge and understanding of the health sector. The Journal is therefore global, and eclectic.