TOPLINE

Emergency department (ED)-initiated hospice and palliative care (HPC) consultations for patients with cancer increased by 388% from 2016 to 2023 across a large US health system, with greater integration of supportive care into emergency care after the onset of the COVID-19 pandemic. The findings highlight the expanding role of the ED in initiating supportive care for patients with serious illness.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from electronic medical records across five hospitals within an integrated health system in the US between 2016 and 2023.
• Among all adults receiving ED-initiated HPC consultations (n = 6370; 6795 ED encounters), researchers assessed the proportion of patients with cancer who received these consultations.
• The outcomes were annual trends in ED-initiated HPC consultation volumes and rates among patients with cancer, clinical characteristics of patients receiving these consultations, distribution of consultation types (hospice only, palliative care only, or both), and patterns of inpatient utilization and disposition.
• Researchers also evaluated consultation patterns before and after the onset of the COVID-19 pandemic (using March 15, 2020, as the cutoff date) and across the five participating EDs.

TAKEAWAY

• Patients with cancer (n = 2639) contributed to 2894 ED encounters and 3407 HPC consultations. Among these patients, ED-initiated HPC consultations increased by 388% between 2016 and 2023 (162 vs 629 consultations; P < .001), with the encounter-based consultation rate increasing from 7.7% to 23.2%. The proportion of hospital-wide ED-initiated HPC consultations involving patients with cancer increased from 6.7% in 2016 to 12.9% in 2023, peaking at 13.6% in 2021.
• Among patients who received ED-initiated HPC consultations, those with cancer had a higher inpatient mortality rate (53.3% vs 49.9%) and lower ICU use (8.8% vs 12.6%) than those without cancer. However, patients with cancer were younger (mean age, 72.7 vs 82.0 years) and less likely to arrive by emergency medical services (55.9% vs 81.2%) than those without cancer. In the cancer cohort, palliative-care-only consultations (57.5%) were most common, followed by hospice-only consultations (30.0%) and combined hospice and palliative care consultations (12.6%).
• Following the onset of the COVID-19 pandemic, ED-initiated HPC consultations increased by 86.3% (1190 before vs 2217 after the pandemic onset; P < .001), with the encounter-based rate increasing from 14.0% to 26.3%. Palliative care consultations increased (from 524 to 1238), whereas hospice consultations declined in both number (from 465 to 405) and proportion (from 39.1% to 18.3%).
• All the participating EDs showed similar upward trends in consultation volume over time, with modest variation between sites.

IN PRACTICE

"Over eight years, ED-initiated palliative care consultations for patients with cancer increased substantially within our health system, with accelerated growth following the COVID-19 pandemic," the authors wrote. 

"This trend reflects a broader shift in how seriously ill oncology patients access supportive care and suggests that long-standing research, guideline development, and advocacy efforts are beginning to translate into routine emergency practice," they added.

SOURCE

The study was led by Satheesh Gunaga, DO, Henry Ford Health and Michigan State University Health Sciences, Detroit. It was published online on June 14, 2026, in The Journal of Emergency Medicine.

LIMITATIONS

The retrospective design and inclusion of a single integrated health system limited the generalizability of the findings. Data on cancer stage, prognosis, performance status, frailty, and multimorbidity were unavailable. The study evaluated consultation trends rather than the appropriateness, quality, or downstream outcomes of ED-initiated HPC consultations. Lastly, the causal factors potentially increasing consultation rates over time were not determined.

DISCLOSURES

The study did not receive any external funding. Some authors reported receiving support from the National Institutes of Health outside this work or honoraria from the John A. Hartford Foundation or serving as volunteers with Compassion & Choices. Detailed disclosures are provided in the original article.

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