NUR 440 Evidence Table Study Citation Design Method Sample Data Collection Data Analysis Validity Reliability Amano, K., Morita, T., Tatara, R., Katayama, H., Uno, T., & Takagi, I. (2015). Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life. Journal of Palliative Medicine , 18 (3), 270–273. Retrieved from - org.ezproxy.snhu.edu/10. 1089/jpm.2014.0132 This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. A retrospe ctive cohort study in a cancer hospital in Japan. 265 cancer decedents from a cancer hospital in Japan The association between early referrals (> 3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score -adapted from the only existing instrument available to quantify the levels of aggressiveness of EOL care. Early palliative care referrals were associated with increased inpatient hospice utilization and less aggressive end of life care. Supports other research with similar results. Limitations due to: retrospective evaluation, lack of patient- reporting, lack early palliative care referral group, single- institution study, lack of information about patients discharged home/moved to nursing home/anothe r hospital.