Palliative Care Initiated in the Emergency Department Associated With Improved Quality of Life
A palliative care consultation initiated in the emergency department for patients with advanced cancer was associated with improved quality of life and did not seem to shorten survival, according to an article published by Grudzen et al in JAMA Oncology.
Visits to the emergency department are common for patients with advanced cancer, and it is during these visits that decisions are often made about the intensity of care. Although the availability of palliative care services continues to increase, consultation typically does not happen until a week into a patient's hospital stay. A consultation initiated from the emergency department may be an opportunity to ensure that care is congruent with a patient's wishes and to interrupt the cascade of intensive, end-of-life care that may be a marker of low-quality care.
Corita R. Grudzen, MD, MSHS, of New York University, and coauthors conducted a randomized clinical trial to compare quality of life, depression, health-care utilization, and survival in emergency department patients with advanced cancer randomly assigned to an intervention with an emergency department–initiated palliative care consultation vs usual care.
The study included 136 patients: 69 receiving the palliative care consultation intervention and 67 receiving usual care, who also may have received a palliative care consultation if it was requested by the admitting team or an oncologist. Among the 69 patients in the intervention, 41 died by the 1-year mark, as did 44 of the 67 patients who received usual care.
Key Findings
The authors report that the palliative care consultation intervention was associated with increased quality-of-life scores from study enrollment to week 12 (average increase of 5.91 points in the intervention group vs an increase of 1.08 in the usual-care group).
Median survival was longer for patients in the intervention group (289 days) compared with the usual-care group (132 days), although the difference was not statistically significant. The lack of statistical significance was due to the highly variable length of survival in the study group, the authors noted.
The authors found no statistically significant differences in depression, admission to the intensive care unit, and discharge to hospice. They suggested that the impact of palliative care on health-care utilization was “more nuanced” in their study.
“Emergency department–initiated palliative care consultation improved [quality of life] in patients with advanced cancer and does not seem to shorten survival; the impact on health-care utilization and depression is less clear and warrants further study,” the study concluded.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
