Emergency department-initiated palliative care screening among older adults: a systematic review and meta-analysis protocol

Dimitri E. Lin, Independent Researcher, Baltimore, Maryland, USA dimitri.lin88@gmail.com.
Satheesh Gunaga, Department of Emergency Medicine, Henry Ford Wyandotte Hospital, Wyandotte, Michigan, USA.
Fabrice I. Mowbray, Nursing, Michigan State University, East Lansing, Michigan, USA.
Eric D. Isaacs, Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Daniel Markwalter, Department of Emergency Medicine, UNC Palliative Care and Hospice Program, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
Naomi George, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Alison E. Hay, Department of Emergency Medicine, Wexford General Hospital, Wexford, Ireland.
Rita Manfredi, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Erica Westlake, Department of Emergency Medicine, Cooper Hospital University Medical Center, Camden, New Jersey, USA.
Murtaza Akhter, Department of Emergency Medicine, Penn State Health, Hershey, Pennsylvania, USA.
Jason K. Bowman, Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
Naomi Rebollo-Lee, Columbia University Medical Center, New York, New York, USA.
Brian Gacioch, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Alexander D. Ginsburg, Department of Emergency Medicine, Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Justin Kenneth Brooten, Department of Emergency Medicine, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Sarah Pajka, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Katie Selman, Department of Emergency Medicine, Cooper Hospital University Medical Center, Camden, New Jersey, USA.
Paul Bain, Countway Library, Harvard Medical School, Boston, Massachusetts, USA.
Joshua J. Davis, Department of Emergency Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA.
Shan Liu, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Kei Ouchi, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Document Type

Journal Article

Publication Date

10-21-2025

Journal

BMJ open

Volume

15

Issue

10

DOI

10.1136/bmjopen-2024-095894

Keywords

ACCIDENT & EMERGENCY MEDICINE; Aging; Emergency Departments; Emergency Service, Hospital; GERIATRIC MEDICINE; PALLIATIVE CARE

Abstract

INTRODUCTION: The rapidly growing population of older adults (individuals aged 65 years and older) presents a new set of challenges for healthcare providers in the emergency department (ED), given the prevalence of severe and life-threatening conditions among this group, such as chronic cancer, Alzheimer's disease/dementia and congestive heart failure. ED encounters often represent a critical point in an older patient's trajectory of care and can thus be an important opportunity for various interventions such as palliative care consultation. Therefore, identifying those who will benefit most from palliative care is of high importance, especially in determining the course of future treatment. Thus, we aim to conduct a systematic review assessing the efficacy of palliative care screening in the ED by assessing inpatient length of stay as the primary outcome and quality of life, percentage of hospitalisation and cost of care as secondary outcomes. METHODS: This study will use Ovid MEDLINE, Embase, EBSCO CINAHL, Web of Science and Cochrane as databases. The study population comprises adults aged 60 years and older, with no focus on any specific clinical specialty or disease. Patients who have not received palliative care screening will serve as the comparator. Only studies with an applicable comparator will be considered. Studies published from 1 January 2000 to 1 July 2025 will be included.All articles will be reviewed independently and in duplicate, and every author will participate in the review, data abstraction and conflict resolution process. ETHICS AND DISSEMINATION: Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42024562389.

Department

Emergency Medicine

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