title: Emergency department attendance by patients with cancer in their last month of life: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To explore factors associated with emergency department (ED) attendance by patients with cancer in their last month of life.
  
  
  METHODS
  Five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) were searched through February 2014 for studies investigating ED attendance toward the end of life by adult patients (age 18 years or older) with cancer. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for ED attendance. Sensitivity analyses explored heterogeneity.
  
  
  RESULTS
  Thirty studies were identified, reporting three demographic, five clinical, and 13 environmental factors, combining data from five countries and 1,181,842 patients. An increased likelihood of ED attendance was found for men (OR, 1.24; 95% CI, 1.19 to 1.29; I(2), 58.2%), black race (OR, 1.45; 95% CI, 1.40 to 1.50; I(2), 0.0%; reference, white race), patients with lung cancer (OR, 1.17; 95% CI, 1.10 to 1.23; I(2), 59.5%; reference, other cancers), and those patients of the lowest socioeconomic status (SES; OR, 1.15; 95% CI, 1.10 to 1.19; I(2), 0.0%; reference, highest SES). Patients receiving palliative care were less likely to attend the ED in their last month of life (OR, 0.43; 95% CI, 0.36 to 0.51; I(2), 59.4%).
  
  
  CONCLUSIONS
  We identified demographic (men; black race), clinical (lung cancer), and environmental (low SES; no palliative care) factors associated with an increased risk of ED attendance by patients with cancer in their last month of life. Our findings may be used to develop screening interventions and assist policy-makers to direct resources. Future studies should also investigate previously neglected areas of research, including psychosocial factors, and patients' and caregivers' emergency care preferences.
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom. lesley.henson@kcl.ac.uk.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Henson
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Melinda
authors.initials: M
authors.lastname: Smith
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Davies
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Ellis-Smith
authors.affiliation: All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Daveson
mesh_terms: D000328:Adult; D000367:Age Factors; D044383:Black People / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000208:ethnology / Q000628:therapy*; D012737:Sex Factors; D019452:Terminally Ill / Q000706:statistics & numerical data*