JAMA Netw Open. 2025 Jul 1;8(7):e2521101. doi: 10.1001/jamanetworkopen.2025.21101.
ABSTRACT
IMPORTANCE: Emergency department (ED) visits among patients with cancer reflect unmet needs and may indicate poor care quality. Outpatient palliative care interventions may help minimize unnecessary ED visits and improve care alignment with patient preferences.
OBJECTIVE: To explore characteristics of ED visits among patients referred to outpatient palliative care, evaluate the potential association of earlier referrals with reduced end-of-life ED visits, and examine when and where advance care planning was completed after outpatient palliative care referral.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted among patients with advanced cancer referred to outpatient palliative care at a tertiary hospital in South Korea, Seoul National University Hospital, between 2018 and 2022, with survival status confirmed as of June 25, 2023.
EXPOSURE: Referral to outpatient palliative care.
MAIN OUTCOMES AND MEASURES: End-of-life ED visits were defined as those occurring within a month before death. Factors associated with overall and end-of-life ED visits, as well as the completion of advance care planning documentation in outpatient palliative care and ED settings, were investigated.
RESULTS: Among 3560 patients with cancer (median [range] age, 68 [18-94] years; 2143 male [60.2%]), 920 patients (25.8%) visited the ED, with a total of 1395 visits. A total of 378 patients in the entire cohort (10.6%) had end-of-life ED visits, accounting for 474 visits. Most visits (958 visits [68.7%]) were related to cancer. Earlier palliative care referral was associated with more overall ED visits (odds ratio, 1.04; 95% CI, 1.02-1.06) but fewer end-of-life ED visits (odds ratio, 0.84; 95% CI, 0.80-0.89). Among 2132 patients who completed advance care planning documentation after referral to palliative care, 331 of 690 ED visitors (48.0%) and 761 of 1442 nonvisitors (52.8%) did so at the outpatient palliative care clinic, while 138 ED visitors (20.0%) completed it at the ED.
CONCLUSIONS AND RELEVANCE: This study found that a substantial number of patients with advanced cancer referred to outpatient palliative care visited the ED, including during the end-of-life phase. Earlier referrals were associated with fewer end-of-life ED visits, emphasizing the need for timely palliative care integration.
PMID:40663348 | DOI:10.1001/jamanetworkopen.2025.21101
