Palliative care consultations initiated in the emergency department (ED) may improve quality of life for advanced cancer patients without shortening survival, according to a recently published study.
ED visits are common for advanced cancer patients and are often the point at which decisions about the intensity of care are made. However, palliative care services are typically not discussed until after a patient has spent a prolonged period of time at the hospital. Palliative care consultations initiated at the ED could help to better inform patients about all possible avenues of care available and prevent intensive, painful interventions near the end-of-life.
To test the effect of palliative care consultations initiated at the ED on quality of life versus normative care in advanced cancer patients, researchers conducted a randomized clinical trial of 136 advanced cancer patients who were presented to the ED between 2011 and 2014. Quality of life was measured using the change in Functional Assessment of Cancer Therapy–General Measure (FACT-G) score at 12 weeks. Results were published in JAMA Oncology.
Sixty-nine participants were allocated to receive palliative care, including a comprehensive consultation to review symptoms, spiritual and social needs, and goals of care. Sixty-seven patients were randomized to receive normal care. Changes in the FACT-G score from enrollment to 12 weeks indicated that quality of life was significantly higher among patients who received a palliative care consultation. Additionally, the consultation group averaged longer survival times than those treated with usual care (289 vs 132 days) although the difference was not statistically significant.
Investigators concluded that ED-initiated palliative care consultations may improve quality of life for patients with advanced cancer without significantly impacting survival. Further study is warranted to identify additional benefits of intervention.
