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Mixed method exploration of the medical, service-related, and emotional reasons for emergency room visits of older cancer patients

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Abstract

Purpose

When dealing with health issues, older cancer patients are likely to visit emergency rooms (ER), which are known to expose these patients to the risk of adverse outcomes. Little is known about the profile and reasons for such visits. The aim of this study is (1) to describe the profile of elderly cancer patients aged 70 years and older who visited the ER of a regional hospital in Québec, Canada, and (2) to explain the medical reasons and factors determining such visits from the patients’ perspective.

Methods

A concurrent mixed method design was used. Descriptive analysis of administrative databases was conducted to describe the socio-demographic, clinical, and service utilization profile of 792 cancer patients aged 70 years and older. Content analysis of 11 semi-structured interviews of a sub-sample was subsequently performed to better understand the experience and meaning these patients attribute to this health behaviour.

Results

The sample of 792 older cancer patients made a total of 1572 ER visits. Most visits occurred during the daytime. More than half (53 %) of the patients were discharged, and close to 40 % were hospitalized. The most frequent reasons for consulting were respiratory (15.8 %), digestive (13.4 %), neurological (8.3 %), fever or infection-related (8.3 %), and cardiovascular (8.2 %). Content analysis of the qualitative data suggested that patients made ER visits mostly when other cancer care services were unavailable or because of a serious life-threatening health condition.

Conclusions

The study suggests areas of improvement to prevent ER visits when health issues can be addressed by other care services.

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References

  1. Société canadienne du cancer (2014) Statistiques canadiennes sur le cancer http://www.cancer.ca/~/media/cancer.ca/CW/publications/Canadian%20Cancer%20Statistics/canadian-cancer-statistics-2013_FR.pdf. Accessed 16 October 2014

  2. Balducci L (2003) New paradigms for treating elderly patients with cancer: the comprehensive geriatric assessment and guidelines for supportive care. J Support Oncol 1(4 Suppl 2):30–37

    PubMed  Google Scholar 

  3. Puts MTE, Papoutsis A, Springall E, Tourangeau AE (2012) A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment. Supp Care Cancer 20(7):1377–1394

    Article  CAS  Google Scholar 

  4. Tremblay D, Roberge D, Nguyen B-L, Charlebois K, Djouder O (2012) Perceived unmet needs of elderly cancer patients in Québec: A descriptive study. J Geriatr Oncol 3(Suppl 1):S99–S100

    Article  Google Scholar 

  5. Delva F, Marien E, Fonck M, Rainfray M, Demeaux J-L, Moreaud P, Soubeyran P, Sasco AJ, Mathoulin-Pélissier S (2011) Factors influencing general practitioners in the referral of elderly cancer patients. BMC Cancer 11(1):1–7. doi:10.1186/1471-2407-11-5

    Article  Google Scholar 

  6. Townsley C, Pond GR, Peloza B, Kok J, Naidoo K, Dale D, Herbert C, Holowaty E, Straus S, Siu LL (2005) Analysis of treatment practices for elderly cancer patients in Ontario, Canada. J Clin Oncol 23(16):3802–3810

    Article  PubMed  Google Scholar 

  7. Delva F, Soubeyran P, Rainfray M, Mathoulin-Pélissier S (2012) Referral of elderly cancer patients to specialists: action proposals for general practitioners. Cancer Treat Rev 38(7):935–941. doi:10.1016/j.ctrv.2012.03.010

    Article  PubMed  Google Scholar 

  8. Gottlieb L, Rowat K (1987) The McGill model of nursing: a practice derived model. Adv Nurs Sci 9(4):51–61

    Article  CAS  Google Scholar 

  9. Kurtz ME, Kurtz JC, Given CW, Given BA (2005) Utilization of services among elderly cancer patients-relationship to age, symptoms, physical functioning, comorbidity, and survival status. Ethn Dis 15(2 Suppl 2):S17–S22

    PubMed  Google Scholar 

  10. Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H (2010) Does frailty predict hospitalization, emergency department visits, and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Crit Rev Oncol Hematol 76(2):142–151. doi:10.1016/j.critrevonc. 2009.10.006

    Article  CAS  PubMed  Google Scholar 

  11. Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur A-M, Roberge D, Larouche D, Verdon J, Pineault R (2007) Continuity of primary care and emergency department utilization among elderly people. Can Med Assoc J 177(11):1362–1368. doi:10.1503/cmaj.061615

    Article  Google Scholar 

  12. McCusker J, Tousignant P, Da Silva RB, Ciampi A, Lévesque J-F, Vadeboncoeur A, Sanche S (2012) Factors predicting patient use of the emergency department: a retrospective cohort study. Can Med Assoc J 184(6):E307–E316. doi:10.1503/cmaj.111069

    Article  Google Scholar 

  13. Roberge D, Larouche D, Pineault R, Lévesque J-F, Hamel M, Simard B (2007) L’urgence hospitalière: Un substitut à la première ligne? Résultats d’une enquête auprès de la population de Montréal et de la Montérégie. Institut national de santé publique du Québec http://www.inspq.qc.ca/pdf/publications/630-UrgenceHospitaliere.pdf. Accessed 26 June 2014

    Google Scholar 

  14. McCusker J, Roberge D, Vadeboncoeur A, Verdon J (2009) Safety of discharge of seniors from the emergency department to the community. Healthc Q 12:24–32

    Article  PubMed  Google Scholar 

  15. Kihlgren AL, Nilsson M, Skovdahl K, Palmblad B, Wimo A (2004) Older patients awaiting emergency department treatment. Scand J Caring Sci 18(2):169–176. doi:10.1111/j.1471-6712.2004.00266.x

    Article  PubMed  Google Scholar 

  16. Kihlgren AL, Nilsson M, Sørlie V (2005) Caring for older patients at an emergency department– emergency nurses’ reasoning. J Clin Nurs 14(5):601–608. doi:10.1111/j.1365-2702.2004.01104.x

    Article  PubMed  Google Scholar 

  17. Boltz M, Parke B, Shuluk J, Capezuti E, Galvin JE (2013) Care of the older adult in the emergency department: nurses views of the pressing issues. Gerontologist 53(3):441–453

    Article  PubMed  PubMed Central  Google Scholar 

  18. Engelhart S, Glasmacher A, Exner M, Kramer MH (2002) Surveillance for nosocomial infections and fever of unknown origin among adult hematology-oncology patients. Infect Control Hosp Epidemiol 23(5):244–248

    Article  PubMed  Google Scholar 

  19. Kamboj M, Sepkowitz KA (2009) Nosocomial infections in patients with cancer. Lancet Oncol 10(6):589–597. doi:10.1016/s1470-2045(09)70069-5

    Article  PubMed  Google Scholar 

  20. Donabedian A (1973) Aspects of medical care administration. Harvard University Press, Cambridge

    Google Scholar 

  21. Pineault R (2012) Comprendre le système de santé pour mieux le gérer. Les Presses de l’Université de Montréal, Montréal

    Google Scholar 

  22. Creswell JW (2009) Research design: Qualitative, quantitative and mixed methods approaches, 3rd edn. SAGE, Nebraska

    Google Scholar 

  23. Direction de la lutte contre le cancer du ministère de la Santé et des Services sociaux du Québec (2008) Le rôle de l’infirmière pivot en oncologie http://www.msss.gouv.qc.ca/sujets/organisation/lutte-contre-le-cancer/documents/role-infirmiere-pivot_juil2008.pdf. Accessed 4 April 2015

  24. Fillion L, Cook S, Veillette A-M, de Serres M, Ml A, Fo R, Fitch M, Doll R (2012) Professional navigation: a comparative study of two Canadian models. Canadian Oncology Nursing Journal 22(4):257–266. doi:10.5737/1181912x224257266

    Article  PubMed  Google Scholar 

  25. Cancer Care Ontario (2004) Pratique des soins infirmiers au téléphone et lignes directrices pour le traitement des symptômes http://www.cano-acio.ca/~ASSETS/DOCUMENT/Resources/TelephoneNursingGuidelines-French.pdf

  26. Stacey D, Bakker D, Green E, Zanchetta M, Conlon M (2007) Ambulatory oncology nursing telephone services: a provincial survey. Canadian Oncology Nursing Journal 17(4):1–5

    Google Scholar 

  27. Laporte L, Bergeron C, Trahan R (2008) Pratique téléphonique en soins infirmiers oncologiques dans un contexte de service de garde. Réseau Cancer Montérégie, Québec April 2008

    Google Scholar 

  28. Miles MB, Huberman MA, Saldaña J (2014) Qualitative data analysis: a methods sourcebook. SAGE, California

    Google Scholar 

  29. Mayer DK, Travers D, Wyss A, Leak A, Waller A (2011) Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol 29(19):2683–2688

    Article  PubMed  PubMed Central  Google Scholar 

  30. Barbera L, Atzema C, Sutradhar R, Seow H, Howell D, Husain A, Sussman J, Earle C, Liu Y, Dudgeon D (2013) Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Ann Emerg Med 61(4):427–437. doi:10.1016/j.annemergmed. 2012.10.010

    Article  PubMed  Google Scholar 

  31. Bozdemir N, Eray O, Eken C, Şenol Y, Artaç M, Samur M (2009) Demographics, clinical presentations and outcomes of cancer patients admitted to the emergency department. Turk J Med Sci 39(2):235–240

    Google Scholar 

  32. Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, Engstrom MC (2000) Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory. Cancer 89(7):1634–1646. doi:10.1002/1097-0142(20001001)89:7<1634::aid-cncr29>3.0.co;2-v

    Article  CAS  PubMed  Google Scholar 

  33. Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D (2012) Emergency department visits for symptoms experienced by oncology patients: a systematic review. Supp Care Cancer 20(8):1589–1599. doi:10.1007/s00520-012-1459-y

    Article  Google Scholar 

  34. Cancer Care Ontario (2005) Edmonton Symptom Assessment system (ESAS). https://www.cancercareonca/common/pages/UserFileaspx?fileId=13262 10 August 2014

  35. Livingston PM, Craike M, Considine J (2011) Unplanned presentations to emergency departments due to chemotherapy induced complications: opportunities for improving service delivery. Australas Emerg Nurs J 14(2):62–68. doi:10.1016/j.aenj.2011.03.005

    Article  Google Scholar 

  36. McKenzie H, Hayes L, White K, Cox K, Fethney J, Boughton M, Dunn J (2011) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Supp Care Cancer 19(7):963–969. doi:10.1007/s00520-010-0913-y

    Article  Google Scholar 

  37. Roberge D, Tremblay D, Turgeon M-È, Berbiche D (2013) Patients’ and professionals’ evaluations of quality of care in oncology outpatient clinics. Supp Care Cancer 21(11):2983–2990. doi:10.1007/s00520-013-1872-x

    Article  Google Scholar 

  38. Roberge D, Pineault R, Larouche D, Poirier L-R (2010) The continuing saga of emergency room overcrowding: are we aiming at the right target? Healthc Policy 5(3):27–39

    PubMed  PubMed Central  Google Scholar 

  39. Lowthian JA, Smith C, Stoelwinder JU, Smit DV, McNeil JJ, Cameron PA (2013) Why older patients of lower clinical urgency choose to attend the emergency department. Intern Med J 43(1):59–65. doi:10.1111/j.1445-5994.2012.02842.x

    Article  CAS  PubMed  Google Scholar 

  40. Hudson SV, Miller SM, Hemler J, Ferrante JM, Lyle J, Oeffinge KC, DiPaola RS (2012) Adult cancer survivors discuss follow-up in primary care: ‘not what I want, but maybe what I need’. Ann Fam Med 10(5):418–427. doi:10.1370/afm.1379

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cancer CPA (2015) The 2015 Cancer System Performance Report, Toronto

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Acknowledgments

We especially thank each and every person involved in this study. Funding for the study was obtained through research scholarships from the Fonds de Recherche du Québec-Santé (FRQ-S), the Quebec Nursing Intervention Research Network (RRISIQ), the Faculty of Medicine and Health Sciences of the Université de Sherbrooke, and the Centre de recherche–Hôpital Charles-Le Moyne.

Author information

Authors and Affiliations

  1. School of Nursing, Université de Sherbrooke, Québec, Canada

    Bich-Lien Nguyen, Dominique Tremblay & Luc Mathieu

  2. CSSS Champlain-Charles-Le Moyne, Greenfield Park, Québec, Canada

    Bich-Lien Nguyen

  3. Charles-Le Moyne Hospital Research Centre, Longueuil, Canada

    Bich-Lien Nguyen & Dominique Tremblay

  4. Research Centre on Aging-CSSS-IUGS, Sherbrooke, Canada

    Luc Mathieu

  5. Division of Social and Transcultural Psychiatry, McGill University, Québec, Canada

    Danielle Groleau

  6. Culture and Mental Health Research Unit, Lady Davis Medical Institute, Jewish General Hospital, Montréal, Canada

    Danielle Groleau

Authors
  1. Bich-Lien Nguyen
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  2. Dominique Tremblay
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  3. Luc Mathieu
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  4. Danielle Groleau
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Corresponding author

Correspondence to Bich-Lien Nguyen.

Ethics declarations

All procedures were in accordance with the ethical standards of the institutional research committee. Protocol AA-HCLM-13-042 and consent forms were submitted and approved by the hospital ethical review board. Written informed consent was obtained from all participants.

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Nguyen, BL., Tremblay, D., Mathieu, L. et al. Mixed method exploration of the medical, service-related, and emotional reasons for emergency room visits of older cancer patients. Support Care Cancer 24, 2549–2556 (2016). https://doi.org/10.1007/s00520-015-3058-1

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  • DOI: https://doi.org/10.1007/s00520-015-3058-1

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