Trends in Hospice and Palliative Care Consults Initiated for Cancer Patients in the Emergency Department

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

adult, aged, cancer patient, Caucasian, cohort analysis, conference abstract, consultation, controlled study, coronavirus disease 2019, distress syndrome, drug therapy, electronic health record, emergency department visit, emergency ward, female, hospice, hospital admission, hospitalization, human, major clinical study, male, malignant neoplasm, palliative therapy, pandemic, retrospective study, surgery, treatment outcome, urban health

Abstract

Background and Objectives: Emergency departments (EDs) are critical touchpoints for cancer patients, who often face acute complications and end-of- life distress. Increasing evidence supports that early palliative care in the ED enhances patient outcomes and goal-concordant care. Our study evaluates temporal trends of ED-initiated hospice and palliative care (HPC) consults for cancer patients. Methods: We conducted a retrospective cohort study using electronic health records (EHR) from five EDs within a large integrated urban and suburban health system between January 2016 and December 2023, focusing specifically on cancer patients. Our study included all ED visits by patients >18 years old, flagged within the EHR as being actively treated for cancer and who had a HPC consult ordered in the ED. Data collected included demographic, clinical, and outcome variables, focusing on trends in ED-initiated HPC consults, with yearly counts and incident rates analyzed to assess changes over the study period and the impact of the COVID-19 pandemic. Statistical significance of these changes over the years was assessed using a series of chi-square and t-tests. Results: Over eight years, a total of 3,407 HPC consults were ordered in the ED, across 2,894 encounters involving 2,639 unique cancer patients. The average patient age was 72.7 years (SD = 13.8), with the majority being White (70.8%). Hospital admission occurred in 92.8% (2,685) of ED encounters, while 5.8% (169) were discharged home, 0.9% (27) died in the ED, and 53.8% (1,537) died during hospitalization. From 2016 to 2023, annual ED HPC consults for cancer patients increased by 399%, from 134 to 534 (p < 0.001). Post-COVID- 19 pandemic, daily ED HPC consults increased by 173% compared to pre-pandemic figures (p < 0.001). Analysis of ED cancer encounters that received HPC consults revealed a significant increase in their proportion of all hospital cancer HPC consults, rising from 9.6% (134/1,390) in 2016 to 19.8% (534/2,703) in 2023 (p < 0.001). Conclusion: This study demonstrates a growing trend of ED and inpatient initiated HPC consultations for cancer patients, particularly post-pandemic, indicating a shift toward earlier palliative care access. While this trend is promising, further research is needed to determine if similar trends are seen nationwide and to identify barriers to the broader implementation of palliative care services for ED cancer patients.

Volume

32

Issue

S1

First Page

206

Last Page

207

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