End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach.
Mary-Joanne Verhoef, Ellen J M de Nijs, Claudia S Ootjers and 6 others
PMID 31867978WHAT IT FOUND
Among patients who died within 3 months after an emergency visit, those with blood cancers had less advance planning, shorter survival, and more often died in hospital and acute hospital settings than those with solid tumors.
Key findings
01Before the emergency visit, limits on life-sustaining treatment were discussed with 16.7% of patients with blood cancers and 37.6% of patients with solid tumors, and documented in 5.1% versus 33.8%.
02After the emergency visit, median survival was 15 days for patients with blood cancers and 18 days for patients with solid tumors, and 67.9% versus 29.5% died in hospital.
03Patients with blood cancers died more often in an acute hospital setting (29.5% versus 2.7%) and less often in hospice (2.6% versus 10.5%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only patients who died within 3 months after an emergency department visit were included, so the study does not describe all patients with these cancers who visit the emergency department. The study was retrospective and single-centre, and discussions about life-sustaining treatment were not routine, so records may be incomplete. The data were collected from 2011 to 2013, and newer treatments may change the pattern of care. No palliative care intervention was tested, so the study cannot show that earlier palliative care would improve outcomes.
The easy way to misread this
Do not read the call for proactive integrated care as proof that it works. This study only described patients who died within 3 months after an emergency visit and did not test palliative care, so it cannot show that earlier palliative care changed survival, hospital death, or hospice use.