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Palliative medicine in the emergency department: symptom control and aggressive care
  1. Raquel de Oliveira1,2,
  2. Carolina B. Lobato1,3,4,
  3. Leonardo Maia-Moço1,5,
  4. Mariana Santos1,
  5. Sara Neves1,
  6. Maria Francisca Matos1,
  7. Rosa Cardoso1,
  8. Carla Cruz1,
  9. Cátia Araújo Silva1,
  10. Joana Dias1,
  11. André Maçães1,
  12. Soraia Almeida6,7,
  13. António Pedro Gonçalves6,
  14. Barbara Gomes8,9 and
  15. Elga Freire1,10
  1. 1 Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
  2. 2 Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  3. 3 Endocrine and Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB) & Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
  4. 4 Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
  5. 5 Cancer Biology and Epigenetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
  6. 6 Emergency Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
  7. 7 Infectious Diseases Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
  8. 8 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  9. 9 Cicely Saunders Institute of Palliative Care and Rehabilitation, Policy and Rehabilitation, King's College London, London, UK
  10. 10 Palliative Care Unit, Department of Internal Medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
  1. Correspondence to Dr Raquel de Oliveira, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto 4050-313, Portugal; raquel.feroli{at}gmail.com

Abstract

Objectives Identifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.

Methods We conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.

Results 384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.

Conclusions Nearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.

  • clinical assessment
  • end of life care
  • hospital care
  • symptoms and symptom management
  • terminal care
  • pain

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Footnotes

  • Contributors All authors contributed to the conception and design of the work. RO, CBL, LMM, MS, SN, MFM, RC, CC, CAS, JD, and AM contributed to the acquisition of data for the work. RO and CBL were responsible for the drafting of the work. RO, CBL, BG, and EF conducted and are responsible for the data analysis. All authors revised the work for important intellectual content. SA and APG gave technical support during the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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