Emergency Department Use by Terminally Ill Patients: A Systematic Review

Amado-Tíneo, José; Oscanoa, Teodoro J.; Vásquez-Alva, Rolando; Huari-Pastrana, Roberto; Delgado-Guay, Marvin Omar

doi:10.1016/j.jpainsymman.2020.08.009

Cited by 22 publications

(7 citation statements)

References 49 publications

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“…We observed a lower utilization of healthcare services among higher-educated patients with heart failure but not for the other two groups of patients. Except for dementia patients, we observed that higher age increased the use of health care services, firmed by numerous other researchers [24,28,29,[32][33][34][35][36][37]. Comorbidity had a weak negative impact on the utilization of healthcare services in our study, a finding echoed by other authors [29,[38][39][40][41].…”

Section: Discussionsupporting

confidence: 80%

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

Hagen,

Zelko

2024

Healthcare

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Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusions: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home.

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Section: Discussionsupporting

confidence: 80%

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

Hagen,

Zelko

2024

Healthcare

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“…A Canadian study revealed that 76,759 patients visited the emergency department 194,017 times during their final 6 months of life [ 7 ]. Additionally, some studies discovered that between 30.7 and 60% of terminal cancer patients visited an emergency department during their last month of life [ 8 – 11 ]. According to studies, a variety of factors contribute to people with advanced cancer seeking care in the emergency department, including uncontrolled symptoms (such as uncontrolled pain, dyspnea, fatigue, and confusion) [ 12 ], incompetent caregivers, concerns or fear about the disease itself, a sense of security when receiving care in a hospital, and difficulty accessing health care facilities in the community, particularly when symptoms change abruptly or occur outside of normal office hours [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

2022

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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.

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“…As indicated by the results of our study, patients with cancer and heart failure are more frequently hospitalized or treated in the emergency department in the last month of life, which typically entails higher treatment costs [32][33][34][35]. The utilization of healthcare services is influenced by numerous factors.…”

Section: Discussionmentioning

confidence: 99%

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

Hagen,

Zelko

2024

Preprint

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Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were most commonly placed in nursing homes, while patients with heart failure and breast cancer were more frequently hospitalized. Breast cancer and heart failure patients had a higher likelihood of dying at home. The presence of general practitioners increased the probability of home-based end-of-life care for cancer patients, while non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusion: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care.

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Emergency Department Use by Terminally Ill Patients: A Systematic Review

Cited by 22 publications

References 49 publications

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

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

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

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