Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study

Victor Wei-Che Shen, Che Yang, Li-Ling Lai, Ying-Ju Chen, Hsien-Hao Huang, Shih-Hung Tsai, Teh-Fu Hsu and David Hung-Tsang Yen
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Victor Wei-Che Shen: School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
Che Yang: Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
Li-Ling Lai: Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
Ying-Ju Chen: School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
Hsien-Hao Huang: School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
Shih-Hung Tsai: Department of Emergency Medicine, National Defense Medical Center, Taipei 114, Taiwan
Teh-Fu Hsu: School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
David Hung-Tsang Yen: School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan

IJERPH, 2021, vol. 18, issue 12, 1-13

Abstract: Emergency units have been gradually recognized as important settings for palliative care initiation, but require precise palliative care assessments. Patients with different illness trajectories are found to differ in palliative care referrals outside emergency unit settings. Understanding how illness trajectories associate with patient traits in the emergency department may aid assessment of palliative care needs. This study aims to investigate the timing and acceptance of palliative referral in the emergency department among patients with different end-of-life trajectories. Participants were classified into three end-of-life trajectories (terminal, frailty, organ failure). Timing of referral was determined by the interval between the date of referral and the date of death, and acceptance of palliative care was recorded among participants eligible for palliative care. Terminal patients had the highest acceptance of palliative care (61.4%), followed by those with organ failure (53.4%) and patients with frailty (50.1%) ( p = 0.003). Terminal patients were more susceptible to late and very late referrals (47.4% and 27.1%, respectively) than those with frailty (34.0%, 21.2%) and with organ failure (30.1%, 18.8%) ( p < 0.001, p = 0.022). In summary, patients with different end-of-life trajectories display different palliative care referral and acceptance patterns. Acknowledgement of these characteristics may improve palliative care practice in the emergency department.

Keywords: palliative care; illness trajectory; emergency department (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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