J Palliat Med. 2023 Apr;26(4):517-526.
doi: 10.1089/jpm.2022.0136. Epub 2022 Dec 22.
Assessing the Acceptability and Feasibility of Leveraging Emergency Department Social Workers’ Advanced Communication Skills to Assess Elderly Patients’ Goals and Values
Emily Loving Aaronson 1 2, Maura Kennedy 1, Grace Gillis-Crouch 3, Hui Zheng 3, Juliet Jacobsen 2, Kei Ouchi 4, Vicki Jackson 2, Christine Seel Ritchie 2 5, Marie Elena Gioiella 6, Jeffrey L Greenwald 3
Abstract
Background: The Emergency Department (ED) has increasingly been recognized as an important site of care for older adults with unmet palliative care needs. Despite this, no clear model of care delivery has emerged.
Aim: To assess the acceptability and feasibility of a scripted palliative care communication intervention in the ED directed by social workers. We hypothesized that the intervention would be feasible, acceptable to patients and ED social workers, and that the collection of patient outcomes would be possible.
Design: A prospective, unblinded, pilot randomized clinical trial of older adults with serious illness presenting to the ED. Patients were randomized to either receive a social worker-directed palliative care intervention (n-65), which consisted of a conversation focused on patients’ goals, values, hopes and worries, or to usual care (n-52). The intervention was evaluated for feasibility and acceptability.
Results: Of patients randomized to the intervention arm, 66% (43/65) completed a conversation with the social worker. Focus group feedback with the social workers further demonstrated the feasibility of these conversations. There was minimal (12%) loss to follow-up. Of the patients who received the intervention, the majority reported that they appreciated the social workers bringing up their goals for the future (77%), their social workers asking about their fears and worries (72%), and they liked the way the conversation was set up (81%). Social workers administered 95% of the conversation components.
Conclusions: This pilot trial demonstrated the feasibility and acceptability of a social worker-directed, scripted palliative care communication intervention in a single urban, academic ED.