Shared Decision Making to Support the Provision of Palliative and End‐of‐Life Care in the Emergency Department: A Consensus Statement and Research Agenda

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Little is known about the optimal use of shared decision making (<jats:styled-content style="fixed-case">SDM</jats:styled-content>) to guide palliative and end‐of‐life decisions in the emergency department (<jats:styled-content style="fixed-case">ED</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use <jats:styled-content style="fixed-case">SDM</jats:styled-content> to guide palliative and end‐of‐life care decisions in the <jats:styled-content style="fixed-case">ED</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient‐advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time‐staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in‐person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Key research questions identified by the group related to which <jats:styled-content style="fixed-case">ED</jats:styled-content> patients are likely to benefit from palliative care (<jats:styled-content style="fixed-case">PC</jats:styled-content>), what interventions can most effectively promote <jats:styled-content style="fixed-case">PC</jats:styled-content> in the <jats:styled-content style="fixed-case">ED</jats:styled-content>, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the <jats:styled-content style="fixed-case">ED</jats:styled-content> to help patients define long‐term goals of care, and what policies influence palliative and end‐of‐life care decision making in the <jats:styled-content style="fixed-case">ED</jats:styled-content>. Answers to these questions have the potential to substantially improve the quality of care for <jats:styled-content style="fixed-case">ED</jats:styled-content> patients with advanced illness.</jats:p></jats:sec>