Comprehensive Home Palliative Care Could Reduce Emergency Department Visits Due to Psychologic Dyspnea Among Cancer Patients: A Retrospective Cohort Study

Abstract Objective Dyspnea symptom is a common trigger of emergency department among the terminal illness and cancer patients. The frequent emergency department (ED) visits at the end of life are the indicator of poor-quality care. We examine the emergency department visits rate due to dyspnea symptom among the palliative patients by enhanced home palliative care.MethodsIn our home palliative care team, patients are managed by palliative care specialists, residents, home care nurses, social workers, and chaplains. We enhanced the weekly home palliative care visit time from 5 days a week to 7 days a week, one to two times visit per week based on patient’s need, to devise team-based medical services and formulate standard operating procedures for dyspnea care.ResultsOur team cared for a total of 762 patients with 512 ED visits, and 178 ED visits because of dyspnea (mean ± SD age, 70.4 ± 13.0 years; 49.4% male). Dyspnea (27.8%) was the most common reason recorded for ED visit, followed by pain (19.0%), GI symptoms (15.7%), and fever (15.3%). The analysis of unexposed versus exposed groups revealed that the proportion of non-family workers (42.9% vs.19.4%) and family members (57.1% vs. 80.6%) acting as caregivers significantly changed than basic (P <0.05). Compared with ED visits of unexposed group, the risks evidently decreased 30.7% in exposed group (P <0.05). Conclusion This study proves that comprehensive home palliative care with add two days per week and formulate standard operating procedures for dyspnea could significantly reduce ED visits rate because of controllable dyspnea in the last six months of life.