Initiating Palliative Care in the ED Improves Quality of Life

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Initiating a palliative care consultation in the emergency department (ED) improved quality of life and survival was not shortened in patients with advanced cancer. These findings were published in JAMA Oncology (doi:10.1001/jamaoncol.2015.5252).

Patients with advanced cancer commonly visit the ED, and decisions regarding intensity of care are often made there. Typically, consultation with palliative care services does not occur until approximately a week into a patient's hospital stay.

A consultation initiated from the ED provides an opportunity to ensure the care is congruent with a patient's wishes. It may also interrupt the cascade of intensive, end-of-life interventions that can be a marker of low-quality care.

This randomized clinical trial included 136 patients; 69 received the palliative care consultation intervention and 67 received usual care. The usual care group was able to receive a palliative care consultation if it was requested by the admitting team or an oncologist. At the 1-year mark, 41 of the patients in the palliative care intervention group and 44 in the usual care group had died.

Quality-of-life scores were increased from study enrollment to week 12 by an average of 5.91 points for patients in the palliative care intervention group versus 1.08 points for the usual care group. Survival was highly variable, so no statistically significant difference occurred between median survival in the intervention group (289 days) and in the usual care group (132 days).

"Future prospective interdisciplinary studies involving the intersection of emergency and/or urgent care, oncology and palliative care practices are necessary to further refine optimal and cost-effective, patient-centered care for patients with cancer and caregivers," wrote Charles R. Thomas Jr., MD, a JAMA Oncology deputy editor, in a related editorial (doi:10.1001/jamaoncol.2015.5665).

A second related editorial (doi:10.1001/jamaoncol.2015.5321), written by Eduardo Bruera, MD, of the University of Texas MD Anderson Cancer Center, in Houston, noted that an ED visit with a patient with advanced cancer provides a unique opportunity to improve access to palliative care and patient's quality of life.

“It is important to define and test criteria for palliative care referral from the ED in daily clinical practices.… It will also be important to understand the attitudes and adherence of patients when referred to outpatient palliative care from the ED. In view of the findings of this study, this research is much needed and justified," wrote Bruera.

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