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. 2022 Nov 15;21(1):197.
doi: 10.1186/s12904-022-01098-w.

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

Netsakao Dumnui  1 , Kittiphon Nagaviroj  2 , Thunyarat Anothaisintawee  1
Affiliations

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

Netsakao Dumnui et al. BMC Palliat 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.

Keywords: Cancer; ED; ER; Emergency department; Emergency room; Palliative care; Visit.

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Conflict of interest statement

All authors declare that we have no conflict of interest in connection with this paper.

Figures

Fig. 1
Fig. 1
Demonstrate patient flow chart from accruing to final analysis
Fig. 2
Fig. 2
Demonstrate the Kaplan-Meier survival analysis between cancer patients who visited the ED to those who did not
See this image and copyright information in PMC

References

    1. Kirkland SW, Garrido Clua M, Kruhlak M, Villa-Roel C, Couperthwaite S, Yang EH, et al. Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs. PLoS One. 2021;16(9):e0257501. doi: 10.1371/journal.pone.0257501. - DOI - PMC - PubMed
    1. Di Leo S, Alquati S, Autelitano C, Costantini M, Martucci G, De Vincenzo F, et al. Palliative care in the emergency department as seen by providers and users: a qualitative study. Scand J Trauma Resusc Emerg Med. 2019;27(1):88. doi: 10.1186/s13049-019-0662-y. - DOI - PMC - PubMed
    1. Giles TM, Hammad K, Breaden K, Drummond C, Bradley SL, Gerace A, et al. Nurses' perceptions and experiences of caring for patients who die in the emergency department setting. Int Emerg Nurs. 2019;47:100789. doi: 10.1016/j.ienj.2019.100789. - DOI - PubMed
    1. Rivera MR, Torres FS. Lack of training and comfort level with provision of palliative Care in Puerto Rican Emergency Departments. Bol Asoc Med P R. 2015;107(2):92–96. - PubMed
    1. Smith AK, Fisher J, Schonberg MA, Pallin DJ, Block SD, Forrow L, et al. Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009;54(1):86–93. doi: 10.1016/j.annemergmed.2008.08.022. - DOI - PubMed