Morphine Administration in the Emergency Department for Dyspnea at the End of Life

Abstract Background Dyspnea is a common and distressing symptom at the end of life, particularly among patients with advanced cancer, heart failure, or chronic lung disease. Morphine, an opioid analgesic, is well established as an effective treatment for relieving dyspnea by modulating the central perception of breathlessness and reducing respiratory effort. However, despite strong evidence and clinical guidelines supporting its use, morphine remains underutilized in the Emergency Department (ED). Studies indicate that many terminally ill patients who could benefit from opioid therapy for dyspnea do not receive it, suggesting barriers related to clinician awareness, attitudes, and comfort with end-of-life care. This study investigates the patterns and determinants of morphine administration in the ED for dyspnea at the end of life and evaluates its association with patient outcomes. Methods A retrospective analysis done on a medical records database of dyspniac patients at the end-of-life adult patients admitted to ED at Shaare-Zedek Medical Center, Israel, between 2023–2024. Statistical analysis was performed on demographic and clinical characteristics of the entire cohort. Results 250 patients included in the research, mean age 83.2 ± 11.5 years, 51.2% female. 15.2% received morphine in the ED, while 68% eventually received morphine during hospitalization. Multivariate logistic regression identified lung cancer (OR = 3.413, p = 0.022), DNR status (OR = 3.173, p = 0.010), and pulse rate upon arrival (OR = 1.022, p = 0.008) as significant predictors of morphine administration in the ED. No significant difference in time to death was found between those who received morphine in the ED (mean = 231.95 hours) and those who did not (mean = 242.64 hours, p = 0.165). However, morphine use during hospitalization was associated with a significant extension in survival (mean = 282.20 hours vs. 152.35 hours, p < 0.001). Conclusions Morphine remains significantly underutilized in the emergency setting, with only 15.2% of terminally ill patients receiving this treatment. Factors such as lung cancer, DNR status, and vital signs influence morphine use in the ED. Although morphine in the ED did not impact time to death, its use during hospitalization was associated with a meaningful extension in survival time.