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

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 illne...

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Autores principales: Shen, Victor Wei-Che, Yang, Che, Lai, Li-Ling, Chen, Ying-Ju, Huang, Hsien-Hao, Tsai, Shih-Hung, Hsu, Teh-Fu, Yen, David Hung-Tsang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296068/
https://www.ncbi.nlm.nih.gov/pubmed/34200689
http://dx.doi.org/10.3390/ijerph18126286
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author Shen, Victor Wei-Che
Yang, Che
Lai, Li-Ling
Chen, Ying-Ju
Huang, Hsien-Hao
Tsai, Shih-Hung
Hsu, Teh-Fu
Yen, David Hung-Tsang
author_facet Shen, Victor Wei-Che
Yang, Che
Lai, Li-Ling
Chen, Ying-Ju
Huang, Hsien-Hao
Tsai, Shih-Hung
Hsu, Teh-Fu
Yen, David Hung-Tsang
author_sort Shen, Victor Wei-Che
collection PubMed
description 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.
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spelling pubmed-82960682021-07-23 Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study Shen, Victor Wei-Che Yang, Che Lai, Li-Ling Chen, Ying-Ju Huang, Hsien-Hao Tsai, Shih-Hung Hsu, Teh-Fu Yen, David Hung-Tsang Int J Environ Res Public Health Article 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. MDPI 2021-06-10 /pmc/articles/PMC8296068/ /pubmed/34200689 http://dx.doi.org/10.3390/ijerph18126286 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shen, Victor Wei-Che
Yang, Che
Lai, Li-Ling
Chen, Ying-Ju
Huang, Hsien-Hao
Tsai, Shih-Hung
Hsu, Teh-Fu
Yen, David Hung-Tsang
Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title_full Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title_fullStr Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title_full_unstemmed Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title_short Emergency Department Referral for Hospice and Palliative Care Differs among Patients with Different End-of-Life Trajectories: A Retrospective Cohort Study
title_sort emergency department referral for hospice and palliative care differs among patients with different end-of-life trajectories: a retrospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296068/
https://www.ncbi.nlm.nih.gov/pubmed/34200689
http://dx.doi.org/10.3390/ijerph18126286
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