A qualitative analysis of cancer-related patient care in the emergency department.

Abstract

Due to an increasing incidence of new cancer diagnoses in the United States and longer survivorship, a growing number of patients with cancer receive care in emergency departments (EDs). This trend places an increasing burden on already crowded EDs, and experts are concerned these patients do not receive optimal care. The purpose of this study was to describe the experiences of ED physicians and nurses who care for patients with cancer. This information can inform strategies to improve oncology care for patients in ED settings. We used a qualitative descriptive design to summarize to the experiences of ED physicians and nurses (n= 23) caring for patients with cancer. We conducted individual, semistructured interviews to query participants about their perspectives on care for oncology patients in the ED. Physician and nurse participants identified 11 challenges and suggested three potential strategies to improve care. The challenges included the following: risk of infection, poor communication between ED staff and other providers, poor communication between oncology or primary care providers and patients, poor communication between ED providers and patients, difficult disposition decisions, new cancer diagnoses, complex pain management, allocation of limited resources, lack of cancer-specific skills among providers, poor care coordination, and evolving end-of-life decisions. The solutions included the following: patient education, education for ED providers, and improved care coordination. Physicians and nurses experience challenges stemming from three overarching types of factors: illness factors, communication factors, and system-level factors. Solutions for the challenges of providing oncology care in the ED call for new strategies at the levels of the patient, provider, institution, and health care system.