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Posted: September 4th, 2022

Perception and Utilization of Emergency Departments by Patients in Palliative Care

Perception and Utilization of Emergency Departments by Patients in Palliative Care
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Palliative care is an approach that aims to improve the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual . Patients with palliative care needs often have complex and unpredictable symptoms that may require urgent attention, leading them to seek care in the emergency department (ED) . However, the ED is not always the optimal place for these patients, as it may expose them to unnecessary interventions, infections, delays, distress and dissatisfaction . Moreover, ED visits may not align with the preferences and goals of care of patients who wish to avoid hospitalization and receive care at home or in a hospice setting .

The aim of this blog post is to explore the perception and utilization of ED by patients in palliative care, based on the existing literature and evidence. We will discuss the reasons why these patients present to the ED, the challenges and opportunities for providing palliative care in the ED setting, and the potential strategies to improve the coordination and integration of palliative care across different settings.

Why do patients in palliative care present to the ED?

According to a retrospective cohort study using a linked dataset from the CUREd database and palliative care services in a region in the North of England, 29.4% of individuals known to palliative care presented to the ED within 90 days of a contact with palliative care . The most common reasons for ED presentations were infections, pain, respiratory problems, gastrointestinal problems and neurological problems . Similarly, a cross-sectional study using data from 18 EDs in Canada found that 12.9% of advanced cancer patients who visited the ED had palliative care needs, and the most frequent chief complaints were dyspnea, pain, weakness and nausea/vomiting .

These findings suggest that patients in palliative care present to the ED mainly because of uncontrolled symptoms or complications that require immediate management. However, there may be other factors that influence their decision to seek emergency care, such as lack of access to community-based palliative care services, inadequate communication and coordination between primary care providers and specialists, lack of advance care planning or documentation of goals of care, family or caregiver stress or crisis, or patient or family preference for aggressive treatment .

What are the challenges and opportunities for providing palliative care in the ED?

Providing palliative care in the ED is challenging for several reasons. First, the ED environment is often crowded, noisy, chaotic and stressful, which may not be conducive to delivering compassionate and holistic care to patients with complex needs . Second, ED staff may lack training, knowledge or confidence in palliative care principles and practices, such as symptom management, communication skills, ethical decision making or end-of-life care . Third, ED staff may face barriers to identify patients who would benefit from palliative care consultation or referral, such as lack of screening tools or criteria, lack of time or resources, or uncertainty about prognosis or goals of care . Fourth, ED staff may encounter difficulties to coordinate care with other providers or services involved in the patient’s care continuum, such as primary care physicians, oncologists, hospice teams or home health agencies .

Despite these challenges, providing palliative care in the ED also offers opportunities to improve patient outcomes and satisfaction. First

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