The Impact of Palliative and End-of-Life Care Educational Intervention in Emergency Departments in Singapore: An...

Background and Objectives: The increasing prevalence of end-of-life care needs in the emergency department necessitates training for emergency staff in managing terminal symptoms, facilitating serious illness conversations and ensuring goal-concordant interventions. This study aims to evaluate the longitudinal effects of an end-of-life care educational intervention on various emergency professionals. Materials and Methods: An interrupted time series study was conducted among emergency physicians and nurses at three public healthcare institutions over two-and-a-half years. The study had three phases: Phase 1-5 pre-intervention surveys, Phase 2-intervention with an online training course, and Phase 3-5 post-intervention surveys. The impact of the intervention was scored based on staff perceptions of end-of-life care in 3 domains: 1. Knowledge of palliative care (Knowledge), 2. Quality of end-of-life care provided (Care), and 3. Ability to communicate with patients and families (Communication). Results: There were 990 participants with 6450 questionnaires distributed and an 87% response rate of completed questionnaires. Phase 3 had generally higher levels of agreement in all 3 domains compared to Phase 1, with a continued upward trend in Knowledge scores. Upward trends in the Care and Communication domains were less pronounced. Among the 631 (out of 990) participants who completed the training, test scores showed a median improvement of 37.5% (p < 0.001). Conclusions: This study supports the feasibility of online end-of-life care training tailored specifically for emergency professionals, with promising results in the Knowledge, Care, and Communication domains. The findings can help guide the further development of training programs or the adoption of similar interventions for basic palliative care training for emergency physicians and nurses.