Resident Education in Palliative Care Increases Resident Understanding of Emergency Department Applications

Early initiation of palliative care (PC) in the emergency department (ED) is known to improve patient-centered outcomes. However, barriers exist among emergency medicine (EM) residents, including limited education in PC and decreased confidence in serious illness goals of care (GOC) discussions. Limited research has examined how dedicated PC curriculum influences EM residents’ primary PC competencies. In this intervention, a 1 hour education was conducted with EM residents during a weekly didactic conference that aimed increase comfort of PC utilization in the ED.

An anonymous pre- and post-intervention IRB-approved survey was collected via RedCap. Surveys included questions regarding demographics, comfort with and knowledge of PC and hospice, and a free text box to identify PC barriers. The post-survey also included a free-text box for anticipated practice changes. Data was analyzed using Pearson’s chi-squared test. Free-text was reviewed qualitatively.

The pre-test and post-test response rates were 74% and 70% respectively. Qualitative data identified pre-intervention barriers of discomfort finding and interpreting advance care planning documents and mixed comfort on discussing palliative care. After the intervention, residents reported a statistically significant increased comfort across several domains: identifying patients appropriate for PC consult (p=0.025) and hospice consult (p=0.01); understanding the difference between advanced care planning documents (p<0.01) and locating these documents (p<0.01); and discussing PC with patients (p<0.01). Access to palliative care during non-business hours was a consistent barrier across pre- and post-test surveys.

This pilot study indicates that targeted short PC education bridges knowledge gaps for EM residents, with the most substantial gains seen in the application of legal documents. Future research is warranted to further characterize how increased resident comfort translates to measurable patient care outcomes.