Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey

Background: Patients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish setting, there is limited literature on the provision of EoLC in EDs and this study, therefore, aimed to evaluate the perceptions of emergency medicine (EM) clinicians regarding the provision of EoLC in EDs in Ireland.

Methods: The End-of-Life Care in Emergency Department Study was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Ireland. This study was conducted through the Irish Trainee Emergency Research Network over a 6-week period from 27 September 2021 to 8 November 2021. Analysis of the survey domains regarding knowledge and attitude has been published previously by the present authors, with this current analysis focusing on communication, education and resources for the provision of EoLC in EDs. Descriptive data on outcomes are reported with additional subgroup analysis according to years of experience in EM.

Results: Of the 694 potential respondents, 311 (44.8%) had fully completed surveys. The majority (62% n=193) were between 25 and 35 years of age with 60% (n=186) having <5 years' experience in EM; 58% (n=180) were men. Experienced respondents (>10 years' experience) were more likely to agree that they were comfortable discussing EoL with patients and families than those with <5 years' experience (80% vs 32%) (p<0.001). Questions on ED infrastructure revealed that just 23.5% agreed that appropriate rooms are allocated for EoL patients, with just 11.6% agreeing that the physical environment is conducive to the provision of EoLC.

Conclusion: EM clinicians agree that they are comfortable breaking bad news and discussing EoLC with patients and families, but disagree that adequate resources and infrastructure are in place to provide a high standard of EoLC in Irish EDs. Challenges exist centred on training and infrastructure and addressing these may lead to enhanced EoLC in the future.