Objective:Providing high-quality, safe, and consistent care for patients with cancer in the emergency department (ED) poses unique challenges. To better understand these challenges, we surveyed oncologists and emergency medicine (EM) physicians across five institutions to identify key areas for improvement in oncologic EM.Methods:In this multi-institutional, cross-sectional qualitative study, a semi-structured survey was administered to EM attending and resident physicians and medical and surgical oncologists across five institutions in 2023. We assessed the open-ended questionnaire responses using thematic analysis; codes were created and collated to generate initial themes. The themes were then reviewed according to specialty for coherence and non-repetition and finalized.Results:Of the 302 surveys accessed, 185 (61.3%) had complete responses. Three main domains of issues emerged: systems-based challenges, direct patient care-related issues, and knowledge gaps. The issues most frequently perceived by oncologist survey respondents were long delays in care (41%), variability in care (25%), and communication issues between the EM physician and oncologist (14%). The issues most frequently perceived by EM physician survey respondents were knowledge gaps in cancer therapeutics (40%) and in general oncologic emergencies (23%); physician comfort level (14%); the timing and/or location of initial discussions about goals of care (13%); and challenges with the follow-up process (12%).Conclusions:Incorporating an interdisciplinary approach to patient care in the ED, improved EM oncologic education, and the development of oncologic specialized EDs may enhance the quality, safety, and consistency of care for patients with cancer in the ED.
目的：在急诊科为癌症患者提供高质量、安全且一致的护理面临独特挑战。为深入理解这些挑战，我们对五家机构的肿瘤科医生和急诊科医生进行了调查，以明确肿瘤急诊护理中需改进的关键领域。 方法：在这项多机构横断面定性研究中，我们于2023年对五家机构的急诊科主治医师、住院医师以及内科与外科肿瘤科医生进行了半结构化问卷调查。采用主题分析法对开放式问卷回答进行评估：通过创建并整理编码形成初始主题，随后按专业对主题进行一致性审查与去重处理，最终确定核心主题。 结果：在收到的302份问卷中，185份（61.3%）为完整回答。问题主要集中于三大领域：系统性挑战、直接患者护理相关问题及知识缺口。肿瘤科医生反馈最集中的问题包括：护理延迟时间过长（41%）、护理方案差异过大（25%）以及急诊科医生与肿瘤科医生间的沟通障碍（14%）。急诊科医生最常提及的问题则涉及：癌症治疗知识缺口（40%）、肿瘤急症基础知识不足（23%）、医师应对信心（14%）、初始治疗目标讨论的时机和/或场所安排（13%）以及随访流程困难（12%）。 结论：在急诊科推行跨学科协作诊疗模式、加强急诊肿瘤学教育培训、建设肿瘤专科急诊单元，有望提升急诊科癌症患者护理的质量、安全性和一致性。
肿瘤(癌症)患者之家