As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in communication strategies that support shared decision making and familiarity with medicolegal terminology increase physician confidence about addressing complaints at the end of life. Familiarity with evidence-based recommendations for symptom management of pain at the end of life aids the emergency physician in creating a positive experience for the patient and their loved ones.
Key points
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Shared decision making between physicians and patients/surrogates should be the framework for all conversations and decisions involving palliative and end-of-life care.
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Patient autonomy is the gold standard for decisions pertaining to care. If patients are unable to communicate; focus on prospective autonomy through substitute decision makers and written directives.
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Alleviation of suffering owing to end-of-life symptoms, whether physical or existential, is the responsibility of the emergency physician.
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Familiarity with evidence-based recommendations about symptom management at end of life is essential.
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