Palliative planning reduces out-of-hours hospital admissions

By Sarah Guy, medwireNews Reporter

Being able to access an electronic palliative care summary (ePCS) for patients with cancer can help doctors make decisions during out-of-hours care and reduce the chances of unplanned hospital admissions, show UK study results.

The findings highlight the importance of proactive planning for symptom management and end-of-life care for patients with terminal cancer, write Rosalind Adam (University of Aberdeen, UK) and colleagues in BMJ Supportive and Palliative Care.

"Pro-active planning for out-of-hours contacts is one way of promoting continuity of care and high quality palliative care and should be encouraged," they say.

The team identified 401 patients with established cancer who consulted a hospital emergency department out-of-hours between January 2011 and December 2011.

Only 36% of participants had an ePCS available at the time of the consultation. The ePCS includes information on patient and carer details, the patient's medical condition, their current care arrangements, the patient and carer's awareness of the condition, and advice for out-of-hours care. The summary also details the patient's preferred place of care and place of death.

This finding was surprising since the hospital existed in an area that piloted an ePCS scheme, note Adam and co-workers.

In all, 100 patients were admitted to hospital following a medical assessment and of these, 21 had a complete ePCS. The absence of an ePCS significantly increased the odds for hospital admission 2.43-fold after adjusting for gender, age, living area (rural or urban), deprivation level, reason for call to hospital (including symptom management and complications of treatment), cancer site (including lung, breast, and colorectal), and 5-year survival prognosis.

"It is intuitively understandable that provision of a structured anticipatory care plan should aid difficult decision making during the out-of-hours period," says the research team.

But they point out that a reduction in hospital admissions, as could be achieved with the widespread introduction of palliative care summaries, would have financial as well as resource allocation implications, in addition to benefiting the patient by enabling them to remain in their chosen place of care.

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