Loading ...

TOPLINE:

A recent retrospective study found that earlier outpatient palliative care referrals for patients with advanced cancer were associated with a small increase in overall emergency department (ED) visits but significantly fewer end-of-life ED visits and improved advance care planning.

METHODOLOGY:

• ED visits near end of life are common among patients with advanced cancer and often indicate unmet needs. Although early outpatient palliative care can improve symptom management and care coordination as well as prevent unnecessary ED visits, it is crucial to distinguish patients who require ED visits from those better managed with planned care.
• To understand how earlier palliative care referrals may impact end-of-life ED visits, researchers conducted a retrospective cohort study of 3560 patients with advanced cancer (median age, 68 years; 60.2% men) referred to outpatient palliative care at Seoul National University Hospital between 2018 and 2022.
• Patients received consultation-based palliative care services from a team of physicians, nurses, and social workers — provided 5 days per week, with telephone support available on weekdays.
• Researchers analyzed ED visits after outpatient palliative care referral, looking at the association between the timing of palliative care referral and end-of-life ED visits as well as the completion of advance care planning documentation in outpatient palliative care and ED settings. Researchers also analyzed end-of-life ED visits — defined as those occurring within 30 days before death — and factors associated with overall and end-of-life ED visits.

TAKEAWAY:

• Overall, 25.8% of patients visited the ED, and 10.6% had an end-of-life ED visit. Earlier palliative care referral was associated with a 4% greater likelihood of an ED visit overall (odds ratio [OR], 1.04), possibly because these patients had longer follow-up, but a 16% reduced likelihood of an ED end-of-life visit (OR, 0.84).
• Factors associated with overall ED visits were age younger than 65 years (OR, 1.25), residence area (OR, 2.92), and planned treatment (OR, 2.60); factors associated with end-of-life visits were residence area (OR, 3.29), hematologic malignancy (OR, 2.79), and planned cancer treatment at referral (OR, 2.60).
• Among 2132 patients who completed advance care planning documentation after referral, 48.0% of ED visitors and 52.8% of nonvisitors completed it at outpatient palliative care clinics, while 20.0% of ED visitors completed it in the ED.
• End-of-life ED visits were more severe and were associated with longer median stays (11.6 vs 8.5 hours), higher rates of hospital admission or transfer (59.7% vs 41.5%), and higher rates of respiratory infections (13.5% vs 4.9%) than other ED visits.
• Regarding interventions, cardiopulmonary resuscitation was performed more frequently during end-of-life ED visits than overall ED visits (3.2% vs 1.2%), with mechanical ventilation and vasopressors used nearly twice as often during end-of-life ED visits.

IN PRACTICE:

A substantial proportion of patients with advanced cancer visited the ED, including during the final month of life. Earlier palliative care referrals were associated with fewer end-of-life ED visits, “emphasizing the importance of timely integration of [palliative care] to reduce unnecessary interventions and ensure goal-concordant care,” the authors wrote. The researchers also noted that the findings underscore the need for structured advance care planning discussions across care settings to enhance the quality of end-of-life care.

SOURCE:

This study, led by Ye Sul Jeung, MD, Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea, was published online in JAMA Network Open.

LIMITATIONS:

The single-center design limited the generalizability of the findings to other settings. This study could not capture data from other EDs where patients may have sought care, potentially leading to incomplete information. Moreover, this study did not consider the complex decision-making processes leading to ED visits, and lacked data on symptom burden or home circumstances to assess the necessity of the visits.

DISCLOSURES:

This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center, funded by the Ministry of Health and Welfare, Republic of Korea. The authors disclosed having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.