Chapter 3 54 To gain more knowledge on the course of events leading to ED visits at the end of life, the objectives of this study were to provide insight into characteristics of advanced cancer patients visiting the ED, their palliative care needs, and the actions undertaken during these ED visits. METHODS Setting This study was conducted at the Leiden University Medical Center (LUMC) in Leiden, the Netherlands. LUMC’s ED is open 24 h a day, 7 days a week. On average, 80 patients are evaluated every day for various reasons, including non-oncological problems. Since 2011, a palliative care consultation team (PCCT) is available in the LUMC for consultation of palliative patients. Patients Adult patients were included who visited the ED between May 2011 and June 2014, were in the palliative phase of cancer at the moment of the ED visit and died within 3 months thereafter. Patients were in the palliative phase if curation was not possible or if anticancer treatment was not directed at curation. The time period of 3 months represents the group of patients in urgent need of appropriate palliative care and appropriate endof-life choices. Also, for the Dutch medical insurance system, this time period depicts the possibility of full reimbursement of necessary palliative home care or transfer to a hospice. Patients diagnosed with a haematological malignancy were excluded. Only data of the last ED visit before death were included. Data collection Characteristics of the patients, referrals, and the ED visit, and follow-up data were retrospectively collected from the electronic patient records (EPRs). The palliative disease phase was assigned by the researcher based on the disease trajectories described by Lynn and Adamson, in which three palliative phase can be discerned corresponding to the disease status: disease-modifying phase, in which anti-cancer treatment is given aimed at life prolongation or symptom management; symptom management phase, in which treatment is directed to symptom relief; or terminal phase.19 EPRs were searched for notes reporting contact with general practitioners (GPs); for PCCT-consultations 3 months before the ED visit; and for proactive symptommanagement plans in files or letters until 6 weeks before the ED visit. Performance was scored using the Eastern Cooperative Oncology Group (ECOG) scale and was documented by the admitting hospital physician or estimated by the researcher based on the patient ’s physical functioning documented
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