Palliative care needs of advanced cancer patients in the emergency department at the end of life 55 in the EPR.20 Limitations on life-sustaining treatments included do-not-resuscitate orders, ‘no ventilation’-orders and ‘no intensive care unit (ICU) admission’-orders. The time of arrival at the hospital was defined as within office hours for visits fromMonday to Friday between 8 a.m. and 6 p.m. The main symptom was defined as the symptom that led to the ED-referral as described in the EPR by the attending physician. New symptoms were defined as main symptoms not mentioned in the EPR 3 months before the ED visit. Acute symptoms were main symptoms with an onset within 24 h before the ED visit. The clinical diagnosis was defined as the conclusion of the attending ED physician. Statistics Characteristics of patients, referral, and ED visit were analysed using descriptive statistics. Kaplan-Meier’s method was employed to estimate survival since the ED visit. The following factors associated with death were derived from literature search and clinical experience: primary lung tumour, ED-admissions for a new and acute problem, limitations on life-sustaining treatments before the ED visit, main symptom at the ED of neurologic deterioration, main symptom at the ED of dyspnoea, clinical diagnosis of bleeding, clinical diagnosis of cachexia, clinical diagnoses of hypercalcemia, and clinical diagnosis of jaundice. These factors were used in univariable and multivariable analyses by using a Cox proportional hazards regression. Predictors with a p value of <0.10 in univariable analysis were entered in multivariable analysis. Differences with a p value <0.05 were considered statistically significant. All analyses were conducted with SPSS 23.0 software. RESULTS Patient characteristics Four hundred twenty patients were included, median age was 63 years, and 229 (54.5%) patients were male (Table 1). Tumours located in the digestive tract occurred most frequently (27.6%). Anti-cancer treatment was provided to 73.6% of the patients in the 3 months before the ED visit. Most patients (62.6%) were in the disease-modifying palliative phase, with average time from diagnosis of the palliative phase to ED visit of 6.2 months (range 0–13.7 months). Most patients (92.6%) lived at home or in a residential home before the ED visit. Home care was arranged for 21.9% of the patients, and 10.5% received home care at least once a day. An informal caregiver was available for 87.1% of the patients. The PCCT was consulted for 26 patients (6.2%) in the last 3 months before the visit to the ED. Proactive symptommanagement plans were documented for 12.1% of the patients 6 weeks before the ED visit. Limitations on life-sustaining treatments had been discussed in 37.6% of the patients, and limitations had been documented in 33.8%. 3
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