Palliative care needs of advanced cancer patients in the emergency department at the end of life 57 Table 1. 420 patients with advanced oncology visiting the emergency department (continued) Patient characteristics n (% of 420) Current housing situationd At home or residential home 389 (92.6) Nursing home 12 (2.9) Hospice 5 (1.2) Home care No 225 (53.6) Yes, unknown frequency 39 (9.3) <1x/day 9 (2.1) ≥1x/day 43 (10.5) Informal caregiver available according to EPR 366 (87.1) PCCT consulted during the last 3 months 26 (6.2) Proactive symptom-management plans In EPR, 6 weeks before the ED-visit 51 (12.1) In a letter to the GP, 6 weeks before the ED-visit 30 (7.1) Discussion with patient mentioned in EPR 6 weeks before the ED-visit 46 (11.0) List of abbreviations: PCCT = palliative care consultation team; EPR = electronic patient record; ED = emergency department; GP = general practitioner a Other: other most common primary tumour sites were unknown primaries; skin tumours; sarcomas; and nasal cavity and middle ear. b Other: nuclear therapy (1%), haemo- or peritoneal dialysis (0.2%), organ transplantation (0.2%), stem cell transplantation (0.2%). c Documented limitations were: no resuscitation: 62 (14.8%); no resuscitation, no ventilation: 11 (2.6%); no resuscitation, no ventilation, no admission to the intensive care unit: 68 (16.2%); refrain from any intervention: 1 (0.2%). d Current living situation was not known for 14 patients (3.3%). Visit characteristics At the ED, imaging and blood tests were performed in 63.3% and 83.3% of the patients, respectively (Table 3). Diagnoses most frequently reported by the attending physician were infection or fever (20.5%), bronchopulmonary insufficiency (12.9%), and renal insufficiency or hydronephrosis (11.2%). Patients spent a median time at the ED equal to 3:29 h (range 00:12–18:01). During or after the ED visit, limitations on life-sustaining treatments were discussed with 73.1% of the patients and 70.7% had limitations documented in the EPR. After the ED visit, 76.0% of the patients were hospitalized. Patients’ median survival from the ED visit was 18 days; 104 patients (24.8%) died within 1 week. Of the 104 patients who died within 1 week, 74 patients (71.2%) died in the hospital and death within 1 week was associated to in-hospital death (p < 0.0001, HR 8.49). In total, 39.3% of the patients died at home, 29.5% in a hospital (i.e., in the clinic, intensive care unit or another hospital) and 11.0% died in a hospice. In-hospital death occurred less frequently in patients with a proactive symptom management plan sent to their GP compared to patients without (26.9% and 38.5%, respectively, p = 0.03). In-hospital death was not related to limitations on life-sustaining treatments, the referrer, or the number of previous admissions. 3
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