Reasons why people at the end of life seek care in the emergency department: a quantitative study
DOI:
https://doi.org/10.29352/mill0218e.41001Keywords:
Palliative Care; terminally ill patient; end-of-life care; emergency medical servicesAbstract
Introduction: The Emergency Department (ED) is frequently sought by people at the end of life, whose palliative needs often conflict with the curative focus of the ED. Specialized Palliative Care (PC) teams can reduce the need for ED visits by alleviating symptoms, avoiding invasive treatments, and generating economic benefits.
Objective: To identify the reasons why people at the end of life seek care in the ED.
Methods: Quantitative, descriptive-correlational, and retrospective study involving 91 individuals followed by the PC team of the Local Health Unit (LHU), who visited the ED and died within 30 days between 01/01/2021 and 12/31/2021. Retrospective document analysis using SPSS. Ethics Committee approval obtained. Descriptive analysis and non-parametric tests were performed.
Results: The majority were male, married/in a civil union, retired, and living with a family member. The most frequent diagnosis was advanced neoplasia. Individuals with a Palliative Performance Scale score of 30–50 visited the ED more often, with dyspnea being the most common symptom. Most did not require curative intervention or life support. Those with only one day of PC follow-up were more likely to visit the ED, especially outside regular hours, typically only once. Statistically significant associations were found between professional status, presence of symptoms, and functional capacity index when correlated with the number of ED visits.
Conclusion: There is a need to restructure healthcare organizations to improve the quality of life for people at the end of life and reduce ED utilization.
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References
Barbosa, A. (2010). Sofrimento. In A. Barbosa & I. Neto (Eds.), Manual de cuidados paliativos (2ª ed.). Núcleo de Cuidados Paliativos do Centro de Bioética da Faculdade de Medicina de Lisboa.
Barbosa, A., Pina, P., Tavares, F., & Neto, I. (2016). Manual de cuidados paliativos (3ª ed.). Faculdade de Medicina da Universidade de Lisboa. https://abrir.link/QYtvQ
Carneiro, R., Barbedo, I., Costa, I., Reis, E., Rocha, N., & Gonçalves, E. (2011). Estudo comparativo dos cuidados prestados a doentes nos últimos dias de vida num serviço de medicina interna e numa unidade de cuidados paliativos. Acta Médica Portuguesa, 24, 545–554. https://www.actamedicaportuguesa.com/
Fassbender, K., Fainsinger, L., Carson, M., & Finegan, A. (2009). Cost trajectories at the end of life: The Canadian experience. Journal of Pain and Symptom Management, 38(1), 75–80. https://www.jpsmjournal.com/article/S0885-3924%2809%2900502-8/fulltext?utm_source=chatgpt.com
Forero, R., McDonnell, G., Gallego, B., McCarthy, S., Mohsin, M., Shanley, C., Formby, F., & Hillman, K. (2012). A literature review on care at the end-of-life in the emergency department. Emergency Medicine International, 2–11. https://doi.org/10.1155/2012/486516
Higginson, I. J., Sarmento, V. P., Calanzani, N., Benalia, H., & Gomes, B. (2013). Dying at home—Is it better? A narrative appraisal of the state of the science. Palliative Medicine, 27, 918–924. https://doi.org/10.1177/0269216313487940
Instituto Nacional de Estatística. (2014). Estatística da saúde. INE. https://www.ine.pt/
Kompanje, E. (2010). The worst is yet to come. Many elderly patients with chronic terminal illnesses will eventually die in the emergency department. Intensive Care Medicine, 36, 732–734. https://link.springer.com/article/10.1007/s00134-010-1803-y
Martins, A., Agnes, P., & Sapeta, P. (2012). Fim de vida no SU: Dificuldades e intervenções dos enfermeiros na prestação de cuidados. Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco. https://core.ac.uk/download/pdf/302935785.pdf
McCusker, J., Karp, I., Cardin, S., Durand, P., & Morin, J. (2003). Determinants of Emergency Department Visits by Older Adults: A Systematic Review. Academic Emergency Medicine, 10(12), 1362–1370. https://doi.org/10.1197/S1069-6563(03)00539-6
Neto, I. (2010). Princípios e filosofia dos cuidados paliativos. In A. Barbosa & I. Neto (Eds.), Manual de cuidados paliativos (pp. 1–42). Faculdade de Medicina da Universidade de Lisboa. https://abrir.link/QYtvQ
Neto, I. (2016a). Cuidados na agonia. In A. Barbosa, P. Pina, F. Tavares, & I. Neto (Eds.), Manual de cuidados paliativos (3ª ed., pp. 317–330). Núcleo de Cuidados Paliativos do Centro de Bioética da Faculdade de Medicina de Lisboa. https://abrir.link/QYtvQ
Neto, I. (2016b). Modelos de controlo sintomático. In A. Barbosa, P. Pina, F. Tavares, & I. Neto (Eds.), Manual de cuidados paliativos (3ª ed., pp. 43–48). Núcleo de Cuidados Paliativos do Centro de Bioética da Faculdade de Medicina de Lisboa.https://abrir.link/QYtvQ
Ordem dos Enfermeiros. (2018). Alocação do enfermeiro especialista em enfermagem médico-cirúrgica na sala de reanimação – Posto de trabalho nos serviços de urgência/emergência. Ordem dos Enfermeiros. https://www.ordemenfermeiros.pt/media/8287/parecer-nº-14_2018_rectificado.pdf
Pacheco, S. (2002). Cuidar a pessoa em fase terminal: Perspectiva ética. Lusociência.
Pedreirinho, A., Godinho, H., Correia, P., Fonseca, A., Crilo, C., Rosa, L., & Santos, S. (2015). Cuidados ao doente em fim de vida no serviço de urgência – uma necessidade em evolução. Onco.News, (30), 16–23. https://onco.news/index.php/journal/article/view/124
Sapeta, P., & Lopes, M. (2007). Cuidar em fim de vida: Factores que interferem no processo de interação enfermeiro-doente. Revista Referência, II (4), 35–60. https://www.redalyc.org/pdf/3882/388239951003.pdf
Veiga, A., Barros, C., Couto, P., & Vieira, P. (2009). Pessoa em fase final de vida: Que intervenções terapêuticas de enfermagem no serviço de urgência? Revista Referência, II (10), 47–56. https://abrir.link/XKGLk
Wentlandt, K., Krzyzanowska, M., Swami, N., Rodin, G., Le, L., & Zimmermann, C. (2012). Referral practices of oncologists to specialized palliative care. Journal of Clinical Oncology. https://www.ncbi.nlm.nih.gov/pubmed/23109708
Wiese, R., Graf, M., & Hanekop, G. (2009). Palliative care and emergency medicine: How can they work together? European Journal of Palliative Care, 16(5), 245–248. https://doi.org/10.1007/s00520-009-0616-4
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