What is the incidence of patients with palliative care needs presenting to the Emergency Department? A critical review

Abstract

Background: Given the context of ageing populations globally, there are a growing number of patients with chronic conditions, some of whom are in the final stages of their disease trajectory, presenting to Emergency Departments. Aim: The aim was to estimate the incidence of patients with palliative care needs presenting to the department. Methods: Three databases (MEDLINE, CINAHL and Embase) were systematically searched up to August 2012. The reference lists of included articles were searched as well as Google and Google Scholar. Only studies in English were included. Two reviewers independently reviewed studies at the abstract and full-body stages. A critical review using systematic methods was undertaken as statistical analysis could not be done because of a lack of information. Results: Only 10 of 1427 identified records met the inclusion criteria. Different definitions of palliative care were evident. One article provided an incidence density for patients with non-small cell lung cancer, and we calculated the mean presentations to be 52.5 per 100 person-months. Two articles focussed on patients known to palliative care services; we estimated that 2.5 in 1000 Emergency Department visits were made by these patients. The review demonstrated that the studies were so different it was not possible to compare the data. Conclusion: There is an absence of evidence regarding the incidence of patients with palliative care needs presenting to the Emergency Department. Further research needs to be undertaken in this area to ensure both clinicians and policymakers have sufficient information for service provision.

Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review

“…However, given that the use of such criteria/ tools in the ED setting has been limited, there is ample room for replication and validation. A recent critical review by Wong et al 42 posit that there is even lack of evidence to clearly demonstrate the incidence of patients with PC needs presenting to the ED, largely attributed to inadequate definitions of ''PC need.'' There is a role for further investigation to identify what specific kinds of agents or advocates in the ED would be most effective to drive earlier patient referrals to PC.…”

Emergency Department-Based Palliative Interventions: A Novel Approach to Palliative Care in the Emergency Department

“…In a recent systematic review, Wong et al were unable to determine the incidence of patients with palliative care needs in the ED due to limitations in available data. 2 Our study shows not only the feasibility of screening in the ED for palliative care needs but also demonstrates high prevalence of unmet care needs in the population sampled. The data from this study may also serve to further support recent calls for prospective interdisciplinary study of ED-based palliative services given the high prevalence of unmet need that was found in this sample.…”

“…U p to 80% of cancer patients visit the emergency department (ED) during the last six months of life, with nearly two-thirds presenting more than once. [1][2][3] The ED is a critical point of care for patients with active cancer; oftentimes, these visits are for care that is palliative in nature, including visits for pain, dyspnea, nausea, vomiting, confusion, and anxiety. 1,[4][5][6] Many of these visits are potentially avoidable if patients with active cancer had earlier access to outpatient palliative care.…”

“…[20][21][22] In addition, the incidence of unmet palliative care needs in ED patients with cancer has not been well characterized. 2,20 Finally, there is limited research on ED-based palliative interventions (EPIs) focused on identifying and addressing palliative needs. The existing studies are limited by their retrospective design.…”

Emergency Medicine and Palliative Care

“…1 However, general guidelines regarding patients that might benefit from both primary and/or subspecialty palliative care interventions in the ED have been identified ( Table 1). Primary palliative care skills critical to the practice of the ED have also been identified (Box 1).…”