Potential Improvements in the Pre-emergency Department Care for Cancer Patients (OVERSEE-I)

Identification of Potential Improvements in the Acute Care Pathway for Cancer Patients in the Emergency Department (OVERSEE - I Trial)

The goal of this single center prospective cross-sectional study is to identify the facilitators and barriers in the course of the disease that starts when symptoms first arise until patients with solid and hematologic malignancies arrive in the emergency department (ED). The main question it aims to answer are: Is there a potential relation between the lag-time and the ED length of stay (LOS) and the chance of admission. Participants will be asked to participate in a one-time interview, that focusses on the pre-admission process.

Study Overview

• Status: Completed
• Conditions: Emergencies; Cancer
• Intervention / Treatment: Behavioral: Emergency department cancer patients interview

Detailed Description

The goal of this single center prospective cross-sectional study is to identify the facilitators and barriers in the course of the disease that starts when symptoms first arise until patients with solid and hematologic malignancies arrive in the emergency department (ED). The main question it aims to answer are: Is there a potential relation between the lag-time and the emergency department length of stay and the chance of admission. Participants will be asked to participate in a one-time interview, that focusses on the pre-admission process. The interview focuses on several parts of the (pre-)admission process: The first part is regarding the timeline that led to an ED visit. The investigators will establish, when and which symptoms were first detected. The second part are regarding the number and type of health care workers that were contacted before visiting the ED. The third part will be about the actions that were taken before the ED visit.

• Study Type: Observational
• Enrollment (Actual): 75

Contacts and Locations

Study Locations

• Netherlands
  • Zuid-Holland
    • Rotterdam, Zuid-Holland, Netherlands, 3015GD
      • Erasmus MC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

In the emergency department (ED) of Erasmus medical center (MC) yearly around 1600 patients with cancer are presented to the ED. Based on the study design we will conduct interviews with 75 to 100 patients with solid and hematologic malignancies, who are receiving systemic therapy or have received systemic therapy within the last 3 months and are admitted to the ED department of the Erasmus MC for the oncology, hematology, lung- and neuro-oncology medical unit. If present, the interview will also be held with the family caregiver.

Description

Inclusion criteria:

• Patients with solid or hematological malignancies and receiving systemic therapy or having received systemic therapy within the last 3 months.
• Presented at or admitted from the emergency department for the oncology, hematology, neuro- or lung-oncology clinical unit.
• Awake and conscious.
• Possible to answer questions within 48 hours after presentation at the emergency department (ED).

Exclusion Criteria:

• <18 years old
• Only received a surgical intervention as cancer treatment
• Admitted to the ED for the surgical department
• Not willing or able to give written informed consent

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Cancer patients; All adult patients with solid or hematological malignancies and receiving systemic therapy or having received systemic therapy within the last 3 months admitted to the emergency department of the Erasmus Medical Center for the oncology, hematology, lung- and neuro-oncology medical unit are eligible for inclusion.

Behavioral: Emergency department cancer patients interview; The interview focuses on several parts of the (pre-)admission process: The first part is regarding the barriers and facilitators encountered during the (pre-)admission process. The second part will focus on the timeline that led to an emergency department (ED) visit. It will be established when and which symptoms were first detected. The third part is regarding the number and type of health care workers that were contacted before visiting the ED. The fourth part will be about the actions and considerations taken before the ED visit.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clusters of facilitators experienced by cancer patients.	Different (sub)clusters of facilitators experienced by cancer patients visiting the emergency department (ED)	Through study completion, an average of 6 months
clusters of barriers experienced by cancer patients.	Different (sub)clusters of barriers experienced by cancer patients visiting the ED	Through study completion, an average of 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lag-time	The time between the first onset of symptoms and a visit to the ED.	Through study completion, an average of 6 months
Disposition	The outcome of a visit to the ED, being either admission or home	Through study completion, an average of 6 months
Patient characteristics	Age, sex, type of cancer, type of complaint, triage category, number of prior visits	Through study completion, an average of 6 months
Correlation between lag-time and ED-LOS	Correlation between lag-time and ED-LOS	Through study completion, an average of 6 months
Correlation between lag-time and disposition	Correlation between lag-time and disposition	Through study completion, an average of 6 months
Correlation between lag-time and patient characteristics	Correlation between lag-time and patient characteristics	Through study completion, an average of 6 months
Time-to-speak	The time between the first notice of symptoms and the first time these complaints were spoken out to the primary giver	Through study completion, an average of 6 months
Time-to-contact	The time between the first time complaints are spoken out and contact is made with a healthcare professional	Through study completion, an average of 6 months
Time-to-present	The time between the first contact with a healthcare professional and the presentation at the ED	Through study completion, an average of 6 months
Difference in group average lag-time between day, evening and night	Difference in group average lag-time between day, evening and night	Through study completion, an average of 6 months
Difference in group average lag-time between weekdays (Monday 08:00 till Friday 23:59) and weekend (Saturday 00:00 and Monday 7:59)	Difference in group average lag-time between weekdays (Monday 08:00 till Friday 23:59) and weekend (Saturday 00:00 and Monday 7:59)	Through study completion, an average of 6 months
Correlation between number of contacted healthcare providers before presentation at the ED and the lag- time.	Correlation between number of contacted healthcare providers before presentation at the ED and the lag- time.	Through study completion, an average of 6 months
Willingness to participate	the percentage of people that participated in this study in comparison to the people approached for this study.	Through study completion, an average of 6 months
ED length of stay (LOS)	The time a patient spends in the ED	Through study completion, an average of 6 months
ED crowding	Measure of business of the ED, composed of the number of patients in the ED and the color coding used for crowding	Through study completion, an average of 6 months

Collaborators and Investigators

• Sponsor: Erasmus Medical Center
• Investigators: Principal Investigator: Jason den Duijn, Erasmus Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): January 29, 2024
• Primary Completion (Actual): September 1, 2024
• Study Completion (Actual): September 1, 2024

Study Registration Dates

• First Submitted: July 18, 2023
• First Submitted That Met QC Criteria: July 26, 2023
• First Posted (Actual): August 3, 2023

Study Record Updates

• Last Update Posted (Actual): October 15, 2024
• Last Update Submitted That Met QC Criteria: October 14, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 10841 (Fred Hutch/University of Washington Cancer Consortium)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No