Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-16-2025

Graduate Advisor

Joshua Minks, DNP

Committee

Elizabeth Segura, DNP

Mindy Weber, LCSW

Abstract

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 patients who screened positive for potential benefits from palliative care. The project was conducted in a 28-bed rural emergency department in southeast Missouri. Providers who assisted in the screening and placement of orders were surveyed after the collection period to evaluate their experience. The most frequently identified interventions for patients included Social Work consultation, medical device use, and therapeutic and supportive medications. The results did not show a high frequency of referrals to palliative care services, despite the high frequency of positive screenings. No significance was found within the Admit, Transfer, or Discharge Categories for disposition. However, findings suggest a relationship between the P-CaRES screening form and the number of patients placed on hospice care during the study period. Analysis of providers’ opinions suggest that the P-CaRES screening is a valuable tool in identifying patients who may benefit from palliative care or hospice services.

Further investigation should be undertaken to expand the role of palliative care screening and hospice screening within the emergency department. Future research should focus on overcoming barriers such as staff involvement, patient assessment, and earlier screening efforts. Expanding the role of screening to both palliative and hospice care may offer more opportunities for individuals with advanced chronic diseases to receive support and quality healthcare for their disease management.

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