Potential Improvements Among Cancer Patients in the Pre-emergency Department Care

Study Overview
=================
Brief Summary
-----------------
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.

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.

Official Title
-----------------
Identification of Potential Improvements Among Cancer Patients and Clinical Staff in the Emergency Department Care Pathway: a Semi-qualitative Study (OVERSEE-I Trial).

Conditions
-----------------
Cancer, Emergencies

Intervention / Treatment
-----------------
* Behavioral: Emergency department cancer patients interview


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with solid and/or hematology malignancies and receiving system therapy Presented at the emergency department or admitted from the emergency department to the oncology, hematology or lung-oncology clinical unit Awake and conscious Possible to answer questions within 48 hours after presentation in the emergency department (ED) Exclusion Criteria: <18 years old Primarily received a surgical intervention as treatment only Admitted to the ED for the surgical department Not willing or able to give written informed consent

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cancer patients<br>All adult patients with solid and hematologic malignancies and receiving systemic therapy admitted to the emergency department of the Erasmus Medical Center (MC) for the oncology, hematology, lung- and neuro-oncology medical unit. | Behavioral: Emergency department cancer patients interview<br>* 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.<br>|

What is the study measuring?
-----------------
Primary 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 | 
| Emergency department (ED) length of stay (ED-LOS) | The time a patient spends in 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 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 |