The role of specialized outpatient palliative care in emergency advance directives: fewer hospitalizations, greater alignment with patient wishes.

CONTEXT

Specialized outpatient palliative care (SOPC) aims at relieving symptoms and providing psychosocial aid in the outpatient setting. SOPC also supports patients in setting up advance directives so that their will is respected in emergency situations.

OBJECTIVES

The aim of this study is to analyze the impact of SOPC on the completion of advance care directives with the focus on medical emergency identification (ID) cards (= living will in a credit card format on yellow paper) and their impact on hospital admissions.

METHODS

All adult patients who were admitted to the SOPC service at a tertiary care center in Germany between 07/2022 and 06/2023 were included in this retrospective cohort study. Demographic data, level of care, information on advance care directives, hospitalizations, adherence to patient wishes, and tumor specific treatments were collected. The data were analyzed using descriptive and inferential measures.

RESULTS

During the study period, 359 patients were included (52.0% female, mean age 74 ± 13 years). A medical emergency ID card was set up by 32.6% ( = 117/359). It was significantly more likely to be created during SOPC than prior to SOPC involvement (before: 20%, after: 80%;  < 0.05). Patients who expressed not wanting to be admitted to hospital in their medical emergency ID card saw significantly less hospital admissions ( < 0.05).

CONCLUSION

SOPC supports patients in setting up medical emergency ID cards. These help in respecting patients’ wishes and prevent unwanted admissions to hospitals, thereby reducing strain on emergency services and emergency departments.