Abstract
BackgroundDuring the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The study aims to show the influence of our palliative care team to reducing emergency calls by cancer patients or their relatives during the last six month of life.MethodsFifty relatives of deceased patients who had been attended by our palliative care team were randomly selected. Data was obtained retrospectively during a structured interview. In addition to demographic data, the number of emergency calls made during the final six months of the patient's life, the reason for the call and the mental compound score (MCS-12) of the caregivers was registered.ResultsForty-six relatives agreed to the interview. Emergency calls were placed for 18 patients (39%) during the final six months of their lives. There were a total of 23 emergency calls. In 16 cases (70%) the patient was admitted to the hospital. Twenty-one (91%) of the calls were made before patients had been enrolled to receive palliative care from the team, and two (9%) were made afterwards. The mean mental compound score of the caregivers at the time of the interview was 41 (range 28–57). There was a lack of correlation between MCS-12 and number of emergency calls.ConclusionEmergency calls were more likely to occur if the patients were not being attended by our palliative care team. Because of the lack of correlation between MCS-12 and the number of emergency calls, the MCS-12 cannot indicate that acutely stressful situations triggered the calls. However, we conclude that special palliative care programs can reduce psychosocial strain in family caregivers. Therefore, the number of emergency calls may be reduced and this fact allows more palliative patients to die at home.
Highlights
During the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures
The following structural approaches for improving the emergency medical care of palliative care outpatients are under discussion: support by our palliative care team significantly reduced the number of emergency calls during the patients' final six months of life (p = 0.032)
The present study shows the influence of our palliative care team during the last six months of life with regard to reducing the number of emergency calls by palliative cancer patients and their relatives
Summary
During the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The onset of acute symptoms during the final stage of a palliative patient's life can place an overwhelming psychosocial burden on the caregiving relatives. These facts can cause the caregivers to call for emergency medical services, which can result in patients being admitted to the hospital [1,2]. Possibilities would be to integrate palliative care teams into the prehospital emergency care, palliative care availability twenty-four hours per day, and advanced care planning [5,6,7]
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