End-of-Life Care, Palliative Care Consultation, and Palliative Care Referral in the Emergency Department: A Systematic Review

• Published in: Journal of pain and symptom management 2020-02, Vol.59 (2), p.372-383.e1
• Main Authors: Wilson, Jennifer G., English, Diana P., Owyang, Clark G., Chimelski, Erica A., Grudzen, Corita R., Wong, Hong-nei, Aslakson, Rebecca A., Aslakson, Rebecca, Ast, Katherine, Carroll, Thomas, Dzeng, Elizabeth, Harrison, Krista L., Kaye, Erica C., LeBlanc, Thomas W., Lo, Shelly S., McKenna, Kelly, Nageswaran, Savithri, Powers, James, Rotella, Joseph, Ullrich, Christina, Vickey, Theresa
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Clinical trials; Cohort analysis; Efficacy; emergency department; emergency medicine; Emergency services; End of life decisions; family reported outcomes; health care utilization; Health services utilization; Health status; hospice; Hospice care; Inpatient care; Intervention; Length of stay; Medical referrals; Medical screening; Mortality rates; Older people; Palliative care; patient-reported outcomes; Patients; Quality of life; Quasi-experimental methods; Systematic review
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2019.09.020

There is growing interest in providing palliative care (PC) in the emergency department (ED), but relatively little is known about the efficacy of ED-based PC interventions. A 2016 systematic review on this topic found no evidence that ED-based PC interventions affect patient outcomes or health care utilization, but new research has emerged since the publication of that review. This systematic review provides a concise summary of current literature addressing the impact of ED-based PC interventions on patient-reported or family reported outcomes, health care utilization, and survival. We searched PubMed, Embase, Web of Science, Scopus, and the Cumulative Index to Nursing and Allied Health Literature from inception until September 1, 2018 and reviewed references. Eligible articles evaluated the effects of PC interventions in the ED on patient-reported or family reported outcomes, health care utilization, or survival. We screened 3091 abstracts and 98 full-text articles with 13 articles selected for final inclusion. Two articles reported the results of a single randomized controlled trial, whereas the remaining 11 studies were descriptive or quasi-experimental cohort studies. More than half of the included articles were published after the previous systematic review on this topic. Populations studied included older adults, patients with advanced malignancy, and ED patients screening positive for unmet PC needs. Most interventions involved referral to hospice or PC or PC provided directly in the ED. Compared with usual care, ED-PC interventions improved quality of life, although this improvement was not observed when comparing ED-PC to inpatient PC. ED-PC interventions expedited PC consultation; most studies reported a concomitant reduction in hospital length of stay and increase in hospice utilization, but some data were conflicting. Short-term mortality rates were high across all studies, but ED-PC interventions did not decrease survival time compared with usual care. Existing data support that PC in the ED is feasible, may improve quality of life, and does not appear to affect survival.