Palliative Care in Patients Admitted to Emergency Departments: Delayed Identification, Disproportionate Interventions, and Factors Associated with the Establishment of Goals of Care

Abstract

Palliative care is an essential approach for patients with serious illnesses, particularly in emergency departments, where clinical decisions must often be made under conditions of instability and prognostic uncertainty. This study aimed to analyze the scientific evidence on the identification of palliative care needs in emergency settings, the use of potentially disproportionate interventions, and the factors associated with defining goals of care. An integrative literature review was conducted using a qualitative approach and narrative synthesis. Studies addressing the recognition of palliative care needs, communication among healthcare professionals, patients and families, decisions regarding invasive support, and continuity of care were considered. The thematic synthesis highlights that screening tools may help identify patients who require palliative assessment, although methodological heterogeneity and the lack of standardized instruments limit their uniform application. Decisions regarding invasive interventions should consider clinical reversibility, expected benefits, and individual preferences, avoiding automatic associations between palliative care and treatment limitation. Shared decision-making, documentation of goals of care, and coordination between healthcare services are essential to improve care quality. Early integration of palliative care into emergency services may support more individualized care aligned with patients’ needs. Further studies are needed to evaluate screening strategies and clinical outcomes.