A study of the factors associated with emergency department visits in advanced cancer patients receiving palliative care

Abstract

Purpose Several studies demonstrated that cancer patients visited the emergency department (ED) frequently. This indicates unmet needs and poor-quality palliative care. We aimed to investigate the factors that contribute to ED visits among patients with advanced cancer in order to identify strategies for reducing unnecessary ED visits among these patients. Methods A retrospective study was conducted between January and December, 2019. Eligible patients were previously enrolled in the comprehensive palliative care program prior to their ED visit. All patients older than 18 were included. Patients were excluded if they had died at the initial consultation, were referred to other programs at the initial consultation, or had an incomplete record. The trial ended when the patients died, were referred to other palliative programs, or the study ended. The time between the initial palliative consultation and study endpoints was categorized into three groups: 16 days, 16–100 days, and > 100 days, based on the literature review. To investigate the factors associated with ED visits, a logistic regression analysis was conducted. The variables with a P value < 0.15 from the univariate logistic regression analysis were included in the multiple logistic regression analysis. Results Among a total of 227 patients, 93 visited the ED and 134 did not. Mean age was 65.5 years. Most prevalent cancers were colorectal (18.5%), lung (16.3%), and hepatobiliary (11.9%). At the end, 146 patients died, 45 were alive, nine were referred to other programs, and 27 were lost to follow-up. In univariate logistic regression analysis, patients with > 100 days from palliative consultation (OR 0.23; 95%CI 0.08, 0.66; p-value 0.01) were less likely to attend the ED. In contrast, PPS 50–90% (OR 2.02; 95%CI 1.18, 3.47; p-value 0.01) increased the ED visits. In the multiple logistic regression analysis, these two factors remained associated with ED visits:> 100 days from the palliative consultation (OR 0.18; 95%CI 0.06, 0.55; p-value 0.01) and PPS 50–90% (OR 2.62; 95%CI 1.44, 4.79; p-value 0.01). Conclusions There was reduced ED utilization among cancer patients with > 100 days of palliative care. Patients having a lower PPS were associated with a lower risk of ED visits.

Predictive factors of basic palliative and hospice care among patients with cancer visiting the emergency department in a Hungarian tertiary care center

“…We found similarly high mortality rates among our patients, with the majority having died within 30 days of their last ED visit (59.9 % and 53.8, among our BPC and HC patients, respectively.) The frequency of cancer type distribution among our patient population, with colorectal, respiratory, and urogenital cancer being most common among them, was similar to other studies [ 33 ], and is in line with the most common causes of cancer mortality in the developed world.…”

“…In our study, the majority of patients receiving BPC or HC were over 65 years old, and slightly more female patients (55 %) visited the ED according. A recent ivestiagtion regarding the emergency department visits of patients with cancer receiving palliative care found that the mean age of patients was 65.5 years and there was a slight majority of men (50.7 %) [ 27 ] as was also found in other previous studies that men were more likely to visit the ED at the end of life [ 28 , 29 ].…”

Missed Opportunity to Diagnose Palliative Care Need Among Older Emergency Department Patients in a Middle-Income Country: A Retrospective Study

“…Conversely, patients with a Palliative Performance Scale between 50% and 90% were more likely to visit the ED. 17 In our study, there were fewer missed opportunities for cancer patients than for patients with other diseases, possibly because ED staff perceive or recognize cancer as a chronic and mostly non-curable disease. Furthermore, there are many studies about PC for cancer 7,23,24 in the ED.…”

“…Conversely, patients with a Palliative Performance Scale between 50% and 90% were more likely to visit the ED. 17 …”

“…14 In Thailand, a small number of hospitals introduced ED palliative care. [15][16][17] The concept of emergency PC started a short time later in 2016, but there is a gap in the information on how well emergency physicians (EPs) perform PC or end-of-life care in the ED. However, there was no official government policy dictating the palliative ED standard of care.…”