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Background Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. Methods A multi-site randomized controlled trial investigating two modes of community-based palliative care delivery for patients in the ED who are discharged home. Research coordinators monitored factors that prevented eligibility and enrollment by screening electronic health records to identify and recruit eligible patients and their caregivers. Reasons for ineligibility and non-participation were documented. Results Among the 7,091 patients who met the age and disease qualifier, 4,292 (60.5%) were deemed ineligible due to hospital admission. Additional reasons for ineligibility included previous palliative care (919 [13%]) or residence in a nursing facility (462 [6.5%]). Of the 695 patients who were eligible, 298 were enrolled, yielding an enrollment rate of 43% (range of 9% to 80% across all sites). Of the 397 eligible patients who did not participate, 180 (45.3%) refused due to barriers related to illness severity. Patients commonly refused due to misconceptions/stigma related to palliative care (118 [29.7%]). One-hundred fifteen patients (29%) refused due to the mode of palliative care delivery. Conclusions Hospital admission from the ED proved to be the most significant barrier to eligibility. Eligible patients often refused participation due to the nature of their illness, misconceptions about palliative care, and concerns about being able to attend clinic visits if assigned to the outpatient arm. |
