Palliative care in the emergency department (ED) has become an essential component of modern healthcare. Emergency clinicians frequently care for patients facing life-limiting illnesses, acute exacerbations of chronic disease, or crises at the end of life. Delivering effective palliative care in this fast-paced environment requires clinicians to master key competencies that combine clinical expertise with compassionate communication.
Recognizing and Managing Palliative Care Needs
One of the most critical skills is early recognition of palliative and end-of-life care needs. This includes identifying patients with:
Progressive, advanced disease with limited prognosis
Acute deterioration in the context of chronic illness
Uncontrolled symptoms, including pain, dyspnea, or delirium
Significant functional decline or frailty
Effective management involves:
-Prompt symptom assessment and relief
-Appropriate use of analgesia, oxygen therapy, and sedation where indicated
-Avoiding unnecessary invasive interventions that may not align with the patient’s goals
Emergency clinicians should also be familiar with clinical tools that help identify palliative trajectories, such as the “surprise question” (“Would I be surprised if this patient died within the next 12 months?”) and validated prognostic indicators.
Communication and Shared Decision-Making
Communication is at the heart of high-quality palliative care. In the ED, time is limited, but thoughtful conversations can make a profound difference for patients and families.
Key communication skills include:
–Eliciting values and goals of care: Understanding what matters most to the patient and family
–Explaining prognosis clearly and honestly: Using language that is simple, sensitive, and free of jargon
–Discussing care preferences: Including resuscitation status, hospitalization, and symptom-focused treatment
–Providing emotional support: Recognizing distress and responding empathetically
Structured approaches such as SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary) can guide these conversations effectively.
Understanding Health Trajectories
Palliative care is grounded in recognizing the different patterns of decline associated with advanced illness. Clinicians should be able to differentiate:
Sudden catastrophic events (e.g., massive stroke)
Steady decline punctuated by acute episodes (e.g., heart failure, COPD)
Gradual progressive deterioration (e.g., dementia, frailty)
This understanding informs care planning, including:
-Anticipating likely clinical scenarios
-Preparing families for expected changes
-Aligning treatment plans with disease trajectory
The Role of the ED in Palliative and End-of-Life Care
Emergency departments often serve as the first point of contact for patients with serious illness. By integrating palliative care principles into routine ED practice, clinicians can:
Improve symptom control and comfort
Support patient autonomy and dignity
Reduce unnecessary hospitalizations and interventions
Facilitate timely referrals to palliative care teams or hospice services
Building Competence and Confidence
Palliative care in the ED is challenging but deeply rewarding. Developing skills in symptom management, effective communication, and recognizing end-of-life trajectories empowers clinicians to provide compassionate, person-centered care—even in moments of crisis.
Ongoing education, interdisciplinary collaboration, and reflective practice are key to sustaining high-quality palliative care in emergency settings.
Recommended Resources:
The Center to Advance Palliative Care (CAPC)
The Emergency Nurses Association (ENA) palliative care modules
The SPIKES protocol for communication
Local palliative care guidelines and support services