Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea
Abstract Background High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED. Methods We co...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-022-00988-3 |
| _version_ | 1811251502874886144 |
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| author | Jung Sun Kim Sun Young Lee Min Sung Lee Shin Hye Yoo Jeongmi Shin Wonho Choi Yejin Kim Hyung Sook Han Jinui Hong Bhumsuk Keam Dae Seog Heo |
| author_facet | Jung Sun Kim Sun Young Lee Min Sung Lee Shin Hye Yoo Jeongmi Shin Wonho Choi Yejin Kim Hyung Sook Han Jinui Hong Bhumsuk Keam Dae Seog Heo |
| author_sort | Jung Sun Kim |
| collection | DOAJ |
| description | Abstract Background High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED. Methods We conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status. Results Of all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%). Conclusions Patients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP. |
| first_indexed | 2024-04-12T16:20:24Z |
| format | Article |
| id | doaj.art-da6ab4022bd4449a98aa4ce57cd88777 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-04-12T16:20:24Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-da6ab4022bd4449a98aa4ce57cd887772022-12-22T03:25:34ZengBMCBMC Palliative Care1472-684X2022-06-0121111110.1186/s12904-022-00988-3Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in KoreaJung Sun Kim0Sun Young Lee1Min Sung Lee2Shin Hye Yoo3Jeongmi Shin4Wonho Choi5Yejin Kim6Hyung Sook Han7Jinui Hong8Bhumsuk Keam9Dae Seog Heo10Department of Internal Medicine, Seoul National University HospitalPublic Healthcare Center, Seoul National University HospitalDepartment of Emergency Medicine, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalCenter for Palliative Care and Clinical Ethics, Seoul National University HospitalDepartment of Internal Medicine, Seoul National University HospitalPatient-Centered Clinical Research Coordinating Center, National Evidence-Based Healthcare Collaborating AgencyAbstract Background High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED. Methods We conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status. Results Of all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%). Conclusions Patients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP.https://doi.org/10.1186/s12904-022-00988-3End-of-life careEmergency departmentDisease-related deaths |
| spellingShingle | Jung Sun Kim Sun Young Lee Min Sung Lee Shin Hye Yoo Jeongmi Shin Wonho Choi Yejin Kim Hyung Sook Han Jinui Hong Bhumsuk Keam Dae Seog Heo Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea BMC Palliative Care End-of-life care Emergency department Disease-related deaths |
| title | Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea |
| title_full | Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea |
| title_fullStr | Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea |
| title_full_unstemmed | Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea |
| title_short | Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea |
| title_sort | aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in korea |
| topic | End-of-life care Emergency department Disease-related deaths |
| url | https://doi.org/10.1186/s12904-022-00988-3 |
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