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Medscape
3 hours ago
- Health
- Medscape
Earlier Palliative Cancer Care Cuts End-of-Life ED Visits
TOPLINE: A recent retrospective study found that earlier outpatient palliative care referrals for patients with advanced cancer were associated with a small increase in overall emergency department (ED) visits but significantly fewer end-of-life ED visits and improved advance care planning. METHODOLOGY: ED visits near end of life are common among patients with advanced cancer and often indicate unmet needs. Although early outpatient palliative care can improve symptom management and care coordination as well as prevent unnecessary ED visits, it is crucial to distinguish patients who require ED visits from those better managed with planned care. To understand how earlier palliative care referrals may impact end-of-life ED visits, researchers conducted a retrospective cohort study of 3560 patients with advanced cancer (median age, 68 years; 60.2% men) referred to outpatient palliative care at Seoul National University Hospital between 2018 and 2022. Patients received consultation-based palliative care services from a team of physicians, nurses, and social workers — provided 5 days per week, with telephone support available on weekdays. Researchers analyzed ED visits after outpatient palliative care referral, looking at the association between the timing of palliative care referral and end-of-life ED visits as well as the completion of advance care planning documentation in outpatient palliative care and ED settings. Researchers also analyzed end-of-life ED visits — defined as those occurring within 30 days before death — and factors associated with overall and end-of-life ED visits. TAKEAWAY: Overall, 25.8% of patients visited the ED, and 10.6% had an end-of-life ED visit. Earlier palliative care referral was associated with a 4% greater likelihood of an ED visit overall (odds ratio [OR], 1.04), possibly because these patients had longer follow-up, but a 16% reduced likelihood of an ED end-of-life visit (OR, 0.84). Factors associated with overall ED visits were age younger than 65 years (OR, 1.25), residence area (OR, 2.92), and planned treatment (OR, 2.60); factors associated with end-of-life visits were residence area (OR, 3.29), hematologic malignancy (OR, 2.79), and planned cancer treatment at referral (OR, 2.60). Among 2132 patients who completed advance care planning documentation after referral, 48.0% of ED visitors and 52.8% of nonvisitors completed it at outpatient palliative care clinics, while 20.0% of ED visitors completed it in the ED. End-of-life ED visits were more severe and were associated with longer median stays (11.6 vs 8.5 hours), higher rates of hospital admission or transfer (59.7% vs 41.5%), and higher rates of respiratory infections (13.5% vs 4.9%) than other ED visits. Regarding interventions, cardiopulmonary resuscitation was performed more frequently during end-of-life ED visits than overall ED visits (3.2% vs 1.2%), with mechanical ventilation and vasopressors used nearly twice as often during end-of-life ED visits. IN PRACTICE: A substantial proportion of patients with advanced cancer visited the ED, including during the final month of life. Earlier palliative care referrals were associated with fewer end-of-life ED visits, 'emphasizing the importance of timely integration of [palliative care] to reduce unnecessary interventions and ensure goal-concordant care,' the authors wrote. The researchers also noted that the findings underscore the need for structured advance care planning discussions across care settings to enhance the quality of end-of-life care. SOURCE: This study, led by Ye Sul Jeung, MD, Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea, was published online in JAMA Network Open. LIMITATIONS: The single-center design limited the generalizability of the findings to other settings. This study could not capture data from other EDs where patients may have sought care, potentially leading to incomplete information. Moreover, this study did not consider the complex decision-making processes leading to ED visits, and lacked data on symptom burden or home circumstances to assess the necessity of the visits. DISCLOSURES: This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center, funded by the Ministry of Health and Welfare, Republic of Korea. The authors disclosed having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Korea Herald
30-06-2025
- Health
- Korea Herald
Korea's softspoken COVID-19 hero poised to return as health chief
Jeong Eun-kyeong, trusted pandemic leader to face looming virus threat, aftermath of unresolved doctor-government conflict As a public health official, Jeong Eun-kyeong is a rare name that many South Koreans recognize. While Jeong had served in public health for decades prior to the pandemic, most came to know her from her leadership at the top of the country's main disease control agency as COVID-19 raged and eventually subsided. When President Lee Jae Myung named Jeong to lead the Health Ministry on Sunday, many of the public health experts who had worked with her cheered. For over two years from COVID-19's onset in February 2020, Jeong was the national doctor that South Koreans counted on for guidance as the country navigated through an unprecedented virus crisis. At least for the first year, she led briefings watched by the whole country, several times a week if not daily, on the COVID-19 situation and safety rules to follow. Jeong was the trusted face of the government's virus response, while politicians and non-experts in higher offices fumbled. The word in the community of infectious disease experts in South Korea at the time was that Jeong was the lonely voice of science in the government, while politicians attempted to meddle in efforts to fight the virus by trying to ease or drop measures too early. Aidedby high compliance with masking and other rules from the public, South Korea was, during its first few waves of infections at least, a model country to the world. Then-President Moon Jae-in and the politicians in the administration tried to claim the credit, but the true hero behind the scenes was Jeong, those with intimate knowledge of what went on agree. Jeong was so well-liked by South Koreans that she was spared by lawmakers of both sides from the annual National Assembly hearings throughout the time she was in charge of COVID-19. This bipartisan decision to let Jeong off the hook in parliamentary hearings scrutinizing the government's response to the pandemic was met by little protest at the time. When Jeong joined Lee's presidential campaign this April, it was a surprise. The softspoken COVID-19 leader, despite her level of public recognition, had made sure to keep a low profile. She rarely gave press interviews and avoided mixing with politics until she left office and disappeared from public sight in October 2022 to work at Seoul National University Hospital as a researcher. Jeong's nomination as health minister comes amid worries about the possible advent of a new virus. From the 2009 H1N1 flu to the 2015 Middle East respiratory syndrome to the 2020 COVID-19, past record shows that a novel virus outbreak tends to strike every five to six years. If another such public health emergency should occur, Korea would be in experienced hands with Jeong. COVID-19 isn't the first infectious disease Jeong had battled in public office. During the 2015 outbreak of MERS, a deadlier if less contagious coronavirus than COVID-19, she headed the disease prevention division at the public health agency. There are also warning signs of a COVID-19 resurgence in the summer. According to a government report published June 10, COVID-19 cases were on the rise for two consecutive weeks in wastewater surveillance. She also inherits an unresolved standoff between doctors and the government over the medical school admissions quota and a series of reforms introduced by former President Yoon Suk Yeol. How the Health Ministry under Jeong will navigate the aftermath of a conflict that partially disrupted the medical system remains unclear. Jeong is a preventive medicine specialist trained at Seoul National University. She first set foot in the public health agency in 1995. arin@
Korea Herald
19-06-2025
- Health
- Korea Herald
SNU family doctor named as physician to president
Park Sang-min, professor of family medicine at Seoul National University Hospital, has been named the official physician to President Lee Jae-myung, Lee's spokesperson Kang Yu-jung said Thursday. Kang said Park will practice Western medicine as Lee's physician. The presidential office has not unveiled the nomination of a personal doctor dedicated to Korean traditional medicine. The 50-year-old Park, who also heads the Health System Data Science Laboratory of Seoul National University's College of Medicine, has accompanied Lee's recent trip to Canada on the occasion of the Group of Seven summit, according to the presidential office. Seoul added that Park is not a full-time employee of the presidential office and will rather remain employed by Seoul National University Hospital.
