Early Palliative Care in the Emergency Department: A Concept Clarification

Area of Science:

• Medical Humanities
• Nursing
• Gerontology

Background:

• Healthcare advances lead to longer lives with chronic illnesses, impacting quality of life (QOL).
• Palliative care (PC) is increasingly used beyond oncology, but its early implementation (EPC) timing is unclear.
• There's a need for an operational definition of EPC to guide interventions in diverse settings, including emergency care (EC).

Purpose of the Study:

• To clarify the concept of early palliative care (EPC).
• To develop an operational definition for EPC.
• To bridge conceptual clarity with empirical data for intervention development and testing in emergency care (EC).

Main Methods:

• Utilized Norris' concept clarification method.
• Conducted an extensive literature search (2000-2024) across CINAHL, PubMed, APA PsychINFO, and Psychology and Behavioral Sciences Collection.
• Screened 826 articles using terms "early palliative care" AND "emergency care", excluding animal and pediatric studies, retaining 22 for review.

Main Results:

• Identified key attributes: timing, palliative, and emergency care (EC).
• Determined antecedents: symptom burden, access to care, and cognitive awareness.
• Consequences included improved QOL and resource utilization; the surprise question ("Would I be surprised if this patient died within a year?") emerged as an empirical referent.

Conclusions:

• Clarifying the concept of EPC is essential.
• An operational definition of EPC will facilitate intervention development.
• This work supports the integration of EPC into emergency department (ED) clinical practice.