Background: frequent visits to the emergency department (ED) is a challenge in the management of patients with active cancer undergoing treatment. These visits are related to cancer complications and treatment-induced adverse effects, are an indicator of poor-quality cancer care. These presentations to the ED could be prevented as the symptoms and adverse effects are mainly predictable. Consequently, stakeholders are interested in identifying interventions that could improve care and reduce the need for patients with cancer to present to the ED.
Objectives: we aimed to answer the following question: what interventions exist to safely and effectively prevent visits to the Emergency Department (ED) among patients with active cancer?
Methods: we proposed a scoping review to map the research in the field, identifying knowledge gaps and the body of evidence suitable to inform healthcare policies. We focused on comparative studies assessing the impact of any non-pharmacological strategy or intervention to reduce ED utilization among adult patients with active cancer. Therefore, our primary outcome was ED utilization, and we excluded studies not assessing or reporting the primary outcome. We searched nine electronic databases and conducted extensive grey literature searches including Google Scholar and handsearches of the recent abstracts of leading emergency medicine conferences (2017 to 2018). We also checked reference lists of the retrieved articles. Two review authors independently performed screening and data extraction, with the participation of a senior emergency clinician-scientist.
Results: we screened 3360 citations and included 25 studies. The included studies comprised a variety of study designs: randomized controlled trials (RCTs) (n = 9), before-after studies (n = 8), prospective (n = 4) and retrospective (n = 3) cohort studies, and controlled before-after study (n = 1). These studies investigated six different types of interventions or strategies to reduce ED visits among patients with cancer (Figure 1). We performed meta-analyses of two before-after studies assessing one type of strategy, and three RCTs assessing another type of intervention; the remaining analyses were narrative considering the high heterogeneity among the studies and interventions assessed.
Conclusions: the scoping review method was effective in identifying the body of the evidence available while also allowing us to map knowledge gaps. It also enabled us to recommend specific comparative trials to inform future decisions. This project demonstrates that scoping reviews can be instrumental in informing stakeholders and future research.
Patient or healthcare consumer involvement: patients informed the relevance of the research question.