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Simple Summary: Patients with advanced cancer frequently seek care in the emergency department and usually present with a constellation of symptoms. In an emergency/urgent setting, it is crucial to understand the severity of these symptoms, which include pain, fatigue, nausea, disturbed sleeping, and distress, as these can greatly influence patient outcomes and the care of cancer patients. In this study, we aimed to explore the relationship between the severity of these symptoms, the diagnosis of delirium, and short-term survival outcomes. Understanding this relationship offers important insights that aid in managing these symptoms, improving patient outcomes, and enhancing a patient's overall quality of life. Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov–Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann–Whitney U test or chi-square test). Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p = 0.018), shortness of breath (p < 0.001), difficulty remembering (p = 0.038), lack of appetite (p = 0.035), drowsiness (p < 0.001), feeling sad (p = 0.031), and interference with walking (p < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04–1.26, p = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05–1.33, p = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83–118 vs. 80, IQR 55–104; p < 0.001). Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients. [ABSTRACT FROM AUTHOR]

A significant portion of oncology patients visit the emergency department (ED) in the last months of their life, often without advanced care plans (ACP). This leads to fragmented care and inconsistent adherence to patients' end-of-life wishes. To enhance the documentation and adherence to advanced care plans for oncology patients visiting the ED, particularly in the context of end-of-life care preferences. This was a retrospective observational study. The data was extracted from Epic ED encounters that occurred during 04/01/2023 through 05/31/2023. Eligibility criteria included patients at least 19 years of age and having at least one of the following: a previous DNR, an out of hospital DNR (OOHDNR), a previous discharge to hospice or an ACP note with Full Code documented as "No". Descriptive statistics using proportions were used to tabulate differences between the two months of data. A multidisciplinary team, including clinicians, spiritual care providers, nurses, social workers, and data analysts, initiated a quality improvement project. The project focused on the integration of spiritual care providers in advanced care planning discussions, the optimization of electronic medical records (EMR) for real time identification and management of patients' care and preferences, and the training of healthcare staff in ACP documentation. During the two-month study period, a total of 5,125 ED encounters occurred with 4,985 potentially eligible patients and 2,747 (55.1%) ED to hospital admissions. The combined number of patients meeting the patient criteria was 276 (5.5%). The intervention led to a 95% increase in the documentation of ACP notes and 46% increase in Do Not Resuscitate (DNR) orders for patients who had previously expressed a preference for a natural death. It highlighted the role of spiritual care providers as a crucial and underutilized resource in managing end-of -life care discussions. This project underscores the importance of interprofessional collaboration in end-of-life care. The utilization of spiritual care providers in ACP discussions and the use of a more integrated EMR system can improve the alignment of emergency care with oncology patients' end-of-life preferences, leading to better patient outcomes and potentially reduced healthcare costs. [ABSTRACT FROM AUTHOR]