title: Do palliative care interventions reduce emergency department visits among patients with cancer at the end of life? A systematic review.
abstract: BACKGROUND
  Frequent emergency department (ED) visits are an indicator of poor quality of cancer care. Coordination of care through the use of palliative care teams may limit aggressive care and improve outcomes for patients with cancer at the end of life.
  
  
  OBJECTIVE
  To systematically review the literature to determine whether palliative care interventions implemented in the hospital, home, or outpatient clinic are more effective than usual care in reducing ED visits among patients with cancer at the end of life.
  
  
  METHODS
  PubMed, EMBASE, and CINAHL databases were searched from database inception to May 7, 2014. Only randomized/non-randomized controlled trials (RCTs) and observational studies examining the effect of palliative care interventions on ED visits among adult patients with cancer with advanced disease were considered.
  
  
  METHODS
  Data were abstracted from the articles that met all the inclusion criteria. A second reviewer independently abstracted data from 2 articles and discrepancies were resolved. From 464 abstracts, 2 RCTs, 10 observational studies, and 1 non-RCT/quasi-experimental study were included. Overall there is limited evidence to support the use of palliative care interventions to reduce ED visits, although studies examining effect of hospice care and those conducted outside of the United States reported a statistically significant reduction in ED visits.
  
  
  CONCLUSIONS
  Evidence regarding whether palliative care interventions implemented in the hospital, home or outpatient clinic are more effective than usual care at reducing ED visits is not strongly substantiated based on the literature reviewed. Improvements in the quality of reporting for studies examining the effect of palliative care interventions on ED use are needed.
authors.affiliation: 1 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: DiMartino
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D019452:Terminally Ill