The identification of facilitators and barriers in the (pre-)emergency care pathway by patients with cancer and their caregivers.

Abstract

e23162 Background: Up to 27% of patients with cancer receiving systemic therapy present to the emergency department (ED), often with long-standing disease- or treatment-related complaints. We defined the period between onset of symptoms and moment of presentation to the ED as lag time. During this lag time, certain factors enable a patient to seek timely care (facilitators), while others prolong lag time (barriers). With this research we aim to identify facilitators and barriers that affect lag time in patients with solid and hematologic malignancies, and to identify factors that prolong the length of stay (LOS) in the ED. Methods: We conducted semi-structured interviews with patients with cancer presenting to the ED and gave questionnaires to the ED nurse, attending physician and treating physician for each patient. Both focused on: (1) the facilitators and barriers (2) actions taken by the patient, his next of kin and by hospital staff, (3) the number of healthcare providers contacted prior to the ED visit, and (4) expected disposition. Results: We included 75 patients, for 58 patients one or more questionnaires were completed by a total of 144 caregivers. The most common motivations for going to the ED were unable to cope at home, intense physical complaints, and need for medical advice. Patients expected treatment and clarity from the ED visit. 29% of patients believed that their visit was preventable, namely by earlier contact by patient, earlier/direct admission to the ward and earlier diagnostics. The most commonly identified factors on LOS in the ED by caregivers were physician workload and awaiting results/diagnostics (both negative effect) and quick communication between caregivers in the ED (positive effect). 31% of patients believed that ED visit could have been prevented with an outpatient clinic visit. Conclusions: We identified multiple factors that significantly affect lag time for cancer patients in the pre-emergency care and ED LOS, which can be used for timely interventions in order to improve patient reported outcomes. Clinical trial information: NCT05974787 & NCT05974800 . Quantitative outcomes. All (N=75) Hospitalized (N=53) Discharged (N=22) Lag Time (days) 8 11 2 Contact moments (#) 3 4 2 ED LOS (h:min) 4:40 5:04 3:42