Outpatient visits a month earlier cut ER visits by 16% for terminal cancer patients

Outpatient visit-based early palliative care reduces the reliance on emergency rooms during the terminal phase of advanced cancer patients, a study showed.

More specifically, for every month the referral to palliative care outpatient services is advanced, the probability of visiting the emergency room during the terminal phase decreases by 16 percent, it said.

Seoul National University Hospital announced on Wednesday that a research team led by Professors Yoo Shin-hye and Jeung Ye-sul of the Palliative Care and Clinical Ethics Center analyzed the emergency room use patterns of 3,560 patients with advanced cancer who were referred to palliative care outpatient clinics from 2018 to 2022, confirming these results.

People with advanced cancer frequently visit the emergency room due to symptoms, including pain, breathing difficulty, and generalized weakness. According to previous reports, 45 percent of patients with advanced cancer visited the emergency room during the terminal phase (one month before death).

However, emergency rooms are not the most suitable places for end-of-life care due to the high likelihood of intensive treatment, making the role of outpatient palliative care clinics in minimizing unnecessary emergency room visits crucial.

Outpatient clinics for palliative care provide comprehensive support for patients with advanced cancer, including specialized symptom management, assistance with advance care planning and living wills, and the development of care plans. They also help patients make informed decisions about their treatment preferences based on their values and preferences as they approach the end of life. However, there have been few studies on the effectiveness of palliative care outpatient clinics.

According to the research team's analysis, one in four patients who received palliative care outpatient services visited the emergency room, and one in 10 patients visited the emergency room during the terminal phase. This is a significantly lower rate compared to previously reported emergency room use rates during the terminal phase, suggesting that early outpatient services for palliative care can reduce dependence on emergency rooms during the terminal phase.

Specifically, the number of emergency room visits and revisits was highest among patients referred to palliative care outpatient services within one month before death, and there was a tendency for the number to decrease as the referral time was earlier. Additionally, for each month that the referral to palliative care outpatient services was earlier, the likelihood of emergency room visits during the terminal phase decreased by 16 percent.

The research team explained that the earlier palliative care outpatient services are provided, the greater the effects on stable symptom management, establishing advance care goals, and education on emergency preparedness, which leads to a decrease in unnecessary emergency room visits.

Additionally, more than half (51 percent) of those who had not previously made an advance care directive did so at the palliative care outpatient clinic, confirming the critical role of palliative care outpatient clinics in facilitating advance care planning discussions. Furthermore, 20 percent of emergency room visitors completed the document in the emergency room, indicating that palliative care outpatient clinics can assist patients in making informed treatment decisions, even in the emergency room environment, where rapid decision-making is necessary.

In comparison, patients referred to palliative care outpatient clinics who were scheduled to undergo chemotherapy were 2.6 times more likely to visit the emergency room during the terminal stage than those who were not. The research team explained that during the terminal stage, adjustments to care plans, including discontinuation of anticancer treatment, are necessary depending on changes in the patient's condition.

“In Korea, only hospice services for terminally ill cancer patients are available under the existing system, and the concept of ‘palliative care’ remains unfamiliar to many people,” Professor Yoo said. “It is necessary to strengthen the institutional infrastructure, including human resources, infrastructure, and reimbursement systems, to ensure stable provision of palliative care in outpatient settings, enabling more patients with advanced cancer to receive support for symptom management and care planning before reaching the terminal stage.”