1 Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
2 Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
J Palliat Med. 2019 Jun;22(6):649-655. doi: 10.1089/jpm.2018.0341. Epub 2019 Feb 5.
Patients with cancer and palliative care needs frequently use the emergency department (ED). ED-based palliative services may extend the reach of palliative care for these patients. To assess the feasibility and reach of an ED-based palliative intervention (EPI) program. A cross-sectional descriptive study of ED patients with active cancer from January 2017 to August 2017. Patients with palliative care needs were identified using an abbreviated 5-question version of the screen for palliative and end-of-life care needs in the ED (5-SPEED). Patients with palliative care needs were then automatically flagged for an EPI as determined by their identified need. The primary outcome was the prevalence of palliative care needs among patients with active cancer. Secondary outcomes were the rate of EPI services successfully delivered to ED patients with unmet palliative care needs, ED length of stay (LOS), and repeat ED visits within the next 10 days. Categorical variables were evaluated using chi-squared or Fischer's exact test as appropriate. Continuous variables were evaluated using analysis of variance. Of the 1278 patients with active cancer, 817 (63.9%) completed the 5-SPEED screen. Of the patients who completed the screen, 422 patients (51.7%) had one or more unmet palliative care needs and 167 (39.6%) received an EPI. There were no differences in ED LOS or 10-day repeat ED visit rates between patients who did or did not receive an EPI. This ED-based intervention successfully screened for palliative needs in cancer patients and improved access to specific palliative services without increasing ED LOS.
患有癌症且有姑息治疗需求的患者经常会使用急诊部（ED）。基于 ED 的姑息治疗服务可能会扩大这些患者的姑息治疗范围。评估一种基于 ED 的姑息治疗干预（EPI）计划的可行性和服务范围。这是一项横断面描述性研究，纳入了 2017 年 1 月至 8 月期间患有活动性癌症的 ED 患者。使用 ED 姑息治疗和临终关怀需求筛查的简短 5 问题版本（5-SPEED）来识别有姑息治疗需求的患者。然后，根据他们确定的需求，自动为有姑息治疗需求的患者标记 EPI。主要结局是有活动性癌症的患者中姑息治疗需求的患病率。次要结局是成功向有未满足姑息治疗需求的 ED 患者提供 EPI 服务的比例、ED 住院时间（LOS）以及在接下来的 10 天内再次 ED 就诊的比例。使用适当的卡方检验或 Fischer 精确检验评估分类变量。使用方差分析评估连续变量。在 1278 例患有活动性癌症的患者中，817 例（63.9%）完成了 5-SPEED 筛查。在完成筛查的患者中，422 例（51.7%）有 1 项或多项未满足的姑息治疗需求，167 例（39.6%）接受了 EPI。接受或未接受 EPI 的患者的 ED LOS 或 10 天内再次 ED 就诊率没有差异。这种基于 ED 的干预措施成功地对癌症患者进行了姑息需求筛查，并在不增加 ED LOS 的情况下改善了特定姑息治疗服务的可及性。
