Table S1.
Survey questions
| 1) Gender |
| A) Female |
| B) Male |
| 2) Job title/rank |
| A) Staff registrar |
| B) Senior resident |
| C) Associate consultant |
| D) Consultant |
| E) Senior consultant |
| 3) Years of practice in emergency department |
| 4) Area of interest/subspecialties |
| 5) Any formal palliative training |
| A) Yes |
| B) No |
| 6) How often do you need to discuss EOL during your daily work? |
| A) Daily |
| B) Weekly |
| C) Every 2 weeks |
| D) Every 3 weeks |
| E) Every monthly |
| 7) How often does patient and/or family agree with your EOL care plans? |
| A) Always |
| B) Generally |
| C) Sometimes |
| D) Seldom |
| E) Rarely |
| 8) How would you resolve any discrepancy or conflicts on EOL discussions? |
| A) Escalate to senior and/or other colleagues |
| B) Defer further discussions to other disciplines |
| C) Try again at a later time |
| D) Involvement of other or more family members |
| E) Proceed with medical management that you deemed most appropriate without further discussions |
| F) Others (please elaborate): _______________________ |
| 9) Please elaborate on above: _____________________________________________ |
| 10) How comfortable are you with EOL discussion with patients and/or NOK in the acute settings (1- very uncomfortable; 5-very comfortable) |
| 11) How comfortable are you with EOL discussions for the following group: Terminally ill or terminally decline in a progressive end-stage disease without any previous documentation of EOL from primary specialists (1-very uncomfortable; 5-very comfortable) |
| 12) How comfortable are you with EOL discussions for the following group: sudden and/or unexpected events such as RTA/sudden cardiopulmonary collapse/pediatric patients (1-very uncomfortable; 5-very comfortable) |
| 13) How comfortable are you with EOL discussions for the following group: Long-term chronic disease with organ failure & dysfunction (1-very uncomfortable; 5-very comfortable) |
| 14) How comfortable are you with EOL discussions for the following group: Elderly/”frailty syndrome” (1-very uncomfortable; 5-very comfortable) |
| 15) Do you prefer to defer the EOL discussion to inpatient team (eg. Palliative team, on-call medical team) |
| Yes |
| No |
| Maybe |
| 16) Does EOL care discussion with patient and/or NOK affect you personally? |
| Yes |
| No |
| Maybe |
| 17) How comfortable are you with de-escalation of care in ED (eg. Weaning down of inotropes, terminal extubations, etcs.) (1-very uncomfortable; 5-very comfortable) |
| 18) Do you routinely debrief your team after EOL discussion? |
| Yes |
| No |
| Sometimes |
| 19) Has COVID-19 pandemic affected your approach to EOL discussion with patients? Please elaborate |
| 20) Please rank the following 10 barriers in order of importance (least to very important): |
| A) Patient’s age |
| B) Access to background information (eg. Spiritual/cultural needs) |
| C) Lack of rapport |
| D) Communication with patient, families and other clinicians |
| E) Understanding of palliative care and evidence-based EOL pathways |
| F) Role uncertainty with lack of collaborative support/partnerships |
| G) Complex and/or lack of support systems and processes in your ED |
| H) Time, space and ED design constrains |
| I) Limited training, experiences and educational resources |
| J) Uncertainty on quality EOL care educational resources |
| Uncertainty on quality EOL care |
EOL: End-of-life