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Abstract

Although research has shown the majority of terminally ill people would prefer to die at home, many who are utilizing homebased hospice end up in the emergency room during their final weeks of life. This integrative review evaluates published studies identifying the causative factors and impact of emergency room visits among home-based hospice patients and their family/caregivers in the last few weeks of life from January 2005 to current. A search of the electronic databases EBSCO Host was utilized as well as the U.S National Library of Medicine/Pub Med, Google Scholar, and the Cumulative Index of National and Allied Health Literature (CINAHL) using key words: Nurse Practitioner, palliative care, hospice, end of life care, and emergency. Data was evaluated using a constant comparative approach as well as thematic content analysis to identify key issues. Thirteen studies from the United States were included as well as ten studies from other countries. From these studies, several factors are addressed including: primary reasons for accessing emergency services, the impact on perceived quality of life and caregiver bereavement outcomes, and prevention and guidance aimed towards reducing hospital admissions. The impact of potentially avoidable end-of-life hospital visits by the terminally ill has been shown to adversely affect quality of life and bereavement outcomes. A comprehensive and coordinated specialist palliative care approach may help minimize the number of patients presenting to the emergency department unnecessarily, thereby helping to maintain them in the setting of their choice for the provision of end-of-life care.

Biography

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