Barriers to recruitment into emergency department-initiated palliative care: a sub-study of a multi-site, randomized controlled trial
Abstract
Background Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. This descriptive analysis explores the barriers to enrolling seriously ill patients scheduled for discharge from the ED into palliative care research. Methods This descriptive sub-study aims to assess the reasons why patients with advanced illness scheduled for discharge home from 11 EDs across the United States decline to participate in Emergency Medicine Palliative Care Access (EMPallA), a Phase IV randomized controlled trial (RCT) comparing two modes of palliative care delivery. Our aim was to understand why patients decline to enroll to improve future recruitment rates and expand care for patients discharged home from the ED. Research coordinators documented reasons that patients declined to enroll in the larger EMPallA trial; reasons for refusing participation were independently analyzed by two researchers to identify overarching themes. Results Enrollment rate across all sites was 45%; of the 504 eligible patients who declined participation, 47% ( n = 237) declined for reasons related to illness severity. 28% of refusals ( n = 143) were related to the mode of palliative care delivery, while 24% ( n = 123) were due to misconceptions or stigma related to palliative care. Less commonly, patients refused due to general…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 504 participants or records.
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