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<p>The integration of formal hospice and palliative pathways within acute emergency care frameworks represents an evolving development in critical care medicine. While structured pathways from the emergency department (ED) to hospice care have shown clinical utility globally, significant gaps remain regarding their reception and outcomes within tertiary healthcare environments in Mainland China. This study evaluated an ED-led “End-of-Life Care” protocol to analyze patient baseline clinical profiles, symptom burdens, and factors determining family caregiver satisfaction. A retrospective observational study design was employed at the Department of Emergency, the First Affiliated Hospital of Sun Yat-sen University, reviewing medical records of terminal patients managed via the protocol between September 1, 2023, and September 25, 2025. Caregiver satisfaction was measured post-discharge using a standardized, single-item follow-up transitional satisfaction question scored via an ordered 5-point Likert scale (partitioned into high, moderate, and low operational tiers) with high internal consistency (Cronbach’s alpha = 0.84). The cohort comprised 45 males (56%) and 35 females (44%) with a mean age of 61.46 ± 4.04 years. Most patients resided in urban areas (55%) and possessed either public (50%) or private (48%) healthcare insurance. 80% presented with significant acute symptom burdens at admission, dominated by pain (30%) and dyspnea (25%). The primary drivers for ED-based hospice transitions were cancer treatments (45%) and cerebrovascular accidents (21.3%). High caregiver satisfaction was reported in 51% of cases, moderate in 33%, and low in 16%. Total inpatient mortality was low (4%) and not statistically linked to satisfaction tiers (<i>p</i> = 0.241). Insurance coverage type was significantly associated with satisfaction (<i>p</i> = 0.004), with private insurance increasing the likelihood of high satisfaction (unadjusted RR = 1.68). Advanced patient age was a significant independent predictor of lower caregiver satisfaction categories (aOR = 0.82 per year; <i>p</i> &lt; 0.001), while private insurance showed a positive trend (OR = 1.78). The acute ED environment serves as a vital gateway for structured end-of-life transitions. Advanced patient age independently predicts lower family satisfaction tiers, indicating that older patient cohorts require optimized communication strategies during acute-to-palliative handoffs. Conversely, access to private commercial insurance infrastructures significantly supports higher caregiver satisfaction outcomes.</p>

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Patient characteristics associated with caregiver satisfaction in emergency department-based hospice transitions

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月27日

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  • Qiuxiang Hu,
  • Jinyun Chu,
  • Lianmei Guo,
  • Meijia Chen,
  • Jing Wang,
  • Xiping Zeng,
  • Lei Peng

摘要

The integration of formal hospice and palliative pathways within acute emergency care frameworks represents an evolving development in critical care medicine. While structured pathways from the emergency department (ED) to hospice care have shown clinical utility globally, significant gaps remain regarding their reception and outcomes within tertiary healthcare environments in Mainland China. This study evaluated an ED-led “End-of-Life Care” protocol to analyze patient baseline clinical profiles, symptom burdens, and factors determining family caregiver satisfaction. A retrospective observational study design was employed at the Department of Emergency, the First Affiliated Hospital of Sun Yat-sen University, reviewing medical records of terminal patients managed via the protocol between September 1, 2023, and September 25, 2025. Caregiver satisfaction was measured post-discharge using a standardized, single-item follow-up transitional satisfaction question scored via an ordered 5-point Likert scale (partitioned into high, moderate, and low operational tiers) with high internal consistency (Cronbach’s alpha = 0.84). The cohort comprised 45 males (56%) and 35 females (44%) with a mean age of 61.46 ± 4.04 years. Most patients resided in urban areas (55%) and possessed either public (50%) or private (48%) healthcare insurance. 80% presented with significant acute symptom burdens at admission, dominated by pain (30%) and dyspnea (25%). The primary drivers for ED-based hospice transitions were cancer treatments (45%) and cerebrovascular accidents (21.3%). High caregiver satisfaction was reported in 51% of cases, moderate in 33%, and low in 16%. Total inpatient mortality was low (4%) and not statistically linked to satisfaction tiers (p = 0.241). Insurance coverage type was significantly associated with satisfaction (p = 0.004), with private insurance increasing the likelihood of high satisfaction (unadjusted RR = 1.68). Advanced patient age was a significant independent predictor of lower caregiver satisfaction categories (aOR = 0.82 per year; p < 0.001), while private insurance showed a positive trend (OR = 1.78). The acute ED environment serves as a vital gateway for structured end-of-life transitions. Advanced patient age independently predicts lower family satisfaction tiers, indicating that older patient cohorts require optimized communication strategies during acute-to-palliative handoffs. Conversely, access to private commercial insurance infrastructures significantly supports higher caregiver satisfaction outcomes.