Effectiveness of Emergency Department Initiated Palliative Care on Hospital Admission, Symptom Control, and 6-Month Outcomes in Low and Middle-Income Countries: A Systematic Review

Abstract

Background: Emergency-department–initiated palliative care (ED-PC) has emerged as a critical strategy for improving the management of patients with advanced, life-limiting illness, particularly in low- and middle-income countries (LMICs) where late presentation, limited specialist availability, and constrained resources frequently compromise care quality. Objective: This systematic review evaluates the effectiveness of ED-PC on hospital admission, acute symptom relief, and 6-month outcomes among adults presenting with serious illness in LMIC settings. Methods: A comprehensive search of PubMed, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was conducted from 2010 to 2024. Eligible studies included randomized trials, quasi-experimental studies, cohort studies, and cross-sectional analyses assessing ED-initiated palliative interventions in LMICs. Two reviewers independently screened, extracted data, and assessed study quality. Outcomes included admission rates, improvement in pain and dyspnea, and 6-month healthcare utilization, mortality, and quality of life. Results: Eighteen studies involving 12,846 patients met inclusion criteria. ED-PC resulted in a 13–22% absolute reduction in hospital admission, substantially greater improvement in pain and dyspnea within hours of ED presentation, and lower 6-month readmission, ED revisits, and ICU utilization. Quality of life improved more in ED-PC groups, with better alignment between preferred and actual care settings. Conclusion: ED-initiated palliative care is effective and feasible in LMIC emergency settings, improving symptom control, reducing avoidable admissions, and enhancing longer-term patient-centered outcomes.