Trial Information

Emergency Department-Based Palliative Care for Advanced Cancer Patients

As the population ages, the number of individual living with cancer will continue to rise,
and the number of Emergency Department (ED) visits for this population will continue to
increase. Cancer patients visit EDs because symptoms, such as pain or vomiting, can't be
controlled at home, in an assisted living facility, or in their provider's office. The ED is
often the only place that can provide the necessary treatments as well as immediate access
to technologically advanced testing for those with cancer. However, palliative care (PC)
services, such as relief of burdensome symptoms), attention to spiritual or social concerns,
and establishing goals of care, is not standard care in the ED outside of a few medical
centers. Most patients do not have well-defined goals of care, and are often subjected to
painful and marginally effective tests and procedures, not because they are consistent with
their goals but because it is less time-consuming than discussing other options and has less
perceived legal risk. Until recently little emphasis has been placed on education, research,
or guidelines for the delivery of PC services in this important setting. While emergency
providers could provide some of these services themselves, knowledge and skills regarding PC
as well as staffing are currently inadequate to provide comprehensive services. In addition
to further decreasing days spent in the hospital and health care costs, consultation by a PC
team for ED cancer patients might also reduce pain and other symptoms, aid in complex
medical decision-making regarding testing and treatments, and facilitate transfer to hospice
or home with visiting nurse services. To enable PC consultation for ED cancer patients, the
investigators will first determine who could benefit from emergent consultation, what
services they need, and what characteristics of emergency providers and hospitals are
preventing them from being offered. To determine what affect PC consultation for patients
with advanced cancer has on symptoms, discussions with patients and families about goals of
care, and how long patients spend in the ED, the investigators will then randomly assign 200
ED cancer patients to targeted PC consultation versus usual or standard care.