Reasons to Access the Emergency Department by Patients Who Receive Palliative Home Care: A Scoping Review

Background: The progressive aging of society has increased the prevalence of chronic, incurable diseases, creating a critical need for palliative care programs. Palliative home care services are essential for patients facing severe symptoms and barriers to accessing health care facilities. Despite this, many patients receiving palliative home care services still access emergency departments (EDs). Objectives: This scoping review aimed to investigate ED visits among patients under palliative home care services, examining factors influencing access, patient characteristics, and leading reasons for ED visits. Methods: A scoping review was conducted by performing a systematic search of Scopus, PubMed, CINAHL, and PsycINFO between 2013 and 2024. Studies focusing on emergency access among adult patients older than 18 years cared for by a palliative home care service were included. Results: Eight retrospective studies across Italy, China, Canada, Australia, and Ireland were included. The studies revealed significant variability in ED visit rates, ranging from 8.6% to 69.15%, with cancer as the predominant diagnosis among patients. Dyspnea, pain, and fever were commonly cited reasons for ED visits, indicating potential gaps in symptom management at home. Discussion: The review highlights the importance of early enrollment in palliative home care services, multidisciplinary care, and better caregiver education to reduce unnecessary ED visits. The findings underscore the need for further research on predictive factors, avoidable versus unavoidable ED visits, and strategies for optimizing home-based palliative care to enhance patient outcomes and quality of life.