[Palliative care and dying in emergency medical services-Attitudes, perspectives and knowledge of emergency physicians].

Abstract

Background: Emergency physicians are confronted with the topic of death and dying almost daily in their work. Demographic changes and the accompanying increase in chronic and incurable diseases at the end of life as well as the frequently expressed wish to die at home, are leading to an increase in emergency situations with palliative patients. To date, there is insufficient data available on how emergency physicians deal with palliative patients.

Method: Emergency physicians from two service providers participated in the survey 'Palliative Care and Dying in Emergency Medical Service'. The emergency physicians were asked to complete a paper-and-pencil survey covering several topics in the areas of palliative medicine and descriptions of conflicts in non-emergency medical situations. They were also asked about their personal attitudes towards dying and death, based on established psychometric standards. The survey was conducted anonymously.

Results: The response rate was 40% (n = 67). Participants had an average age of 41 years, and 66% (n = 44) were male. The majority of emergency physicians surveyed were anaesthetists and had worked as emergency physicians for more than five years. Only six respondents (9%) had an additional training in palliative medicine. On average, more experienced doctors felt better prepared to deal with dying patients than those with less than five years' professional experience as emergency physicians. The survey showed that many emergency physicians experience a conflict between end-of-life care and saving lives when treating palliative patients. None of the respondents stated that palliative medicine had nothing to do with emergency medicine. The emergency physicians surveyed expressed uncertainty regarding the acute preclinical care of palliative patients.

Conclusion: The expertise of emergency physicians in palliative medicine increases with the level of operational experience. Almost all respondents consider this topic to be very important and would like to see it integrated more strongly into training and continuing professional education. A lack of knowledge may result in palliative patients being offered less meaningful therapies, which could lead to hospitalisation. Demographic changes will increase the need for emergency physicians with expertise in palliative medicine. The discrepancy identified must be addressed.