An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views
The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We condu...
Gespeichert in:
| Veröffentlicht in: | PloS one 2019-05, Vol.14 (5), p.e0216430-e0216430 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e0216430 |
|---|---|
| container_issue | 5 |
| container_start_page | e0216430 |
| container_title | PloS one |
| container_volume | 14 |
| creator | Chen, Hong Walabyeki, Julie Johnson, Miriam Boland, Elaine Seymour, Julie Macleod, Una |
| description | The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care. |
| doi_str_mv | 10.1371/journal.pone.0216430 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2219680292</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A584225379</galeid><doaj_id>oai_doaj_org_article_093aa398602947c283fe24c79bb9f3a2</doaj_id><sourcerecordid>A584225379</sourcerecordid><originalsourceid>FETCH-LOGICAL-c692t-d5c171e442c6b4716f4d0f0b669e8f480ea81418ef3b755e5c08d461036dcae93</originalsourceid><addsrcrecordid>eNqNk9tu1DAQhiMEoqXwBggsIXG42MWOHcfhAqmqOFSqVHG8tbz2JOsqsYOdLO378WA4u2nVRb1AuUgy880_nhlPlj0leEloSd5e-DE41S5772CJc8IZxfeyQ1LRfMFzTO_f-j7IHsV4gXFBBecPswNKMBOiLA6zP8cOWTdAE9QABo3OQIiDcsa6BvkaDWtA2nd9C5fIBLtJ3skMHYQGnL5CfYAIblCD9S6iFIiU6WyM21_rkFZOQ0B9AhIW36Evo2rtxG8Add5A286pImjvjApXC60CoDWodlgnfV_DVk618RWCyx5CUtKwS7ax8Ds-zh7UyQtP5vdR9uPjh-8nnxdn559OT47PFppX-bAwhSYlAcZyzVesJLxmBtd4xXkFomYCgxKEEQE1XZVFAYXGwjBOMOVGK6joUfZ8p9u3Psp5AFHmOam4wHmVJ-J0RxivLmQfbJfqkV5ZuTX40EgVBqtbkLiiStFK8BTISp0LWkPOdFmtVlVN1aT1fs42rjowOrUvqHZPdN_j7Fo2fiM5q0oqaBJ4PQsE_2uEOMg0GJ0arhz4cTp3OjIrOJnQF_-gd1c3U41KBVhX-5RXT6LyuBAszwtaTl1a3kGlx0Bn04ihtsm-F_BmLyAxA1wOjRpjlKffvv4_e_5zn315i93dp-jbcXtV90G2A3XwMQaob5pMsJyW7bobclo2OS9bCnt2e0A3QdfbRf8CpyMpfA</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2219680292</pqid></control><display><type>article</type><title>An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views</title><source>MEDLINE</source><source>Public Library of Science</source><source>Full-Text Journals in Chemistry (Open access)</source><source>PubMed Central</source><source>Directory of Open Access Journals</source><source>EZB Electronic Journals Library</source><creator>Chen, Hong ; Walabyeki, Julie ; Johnson, Miriam ; Boland, Elaine ; Seymour, Julie ; Macleod, Una</creator><contributor>Cheungpasitporn, Wisit</contributor><creatorcontrib>Chen, Hong ; Walabyeki, Julie ; Johnson, Miriam ; Boland, Elaine ; Seymour, Julie ; Macleod, Una ; Cheungpasitporn, Wisit</creatorcontrib><description>The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0216430</identifier><identifier>PMID: 31048875</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ambulatory Care ; Analysis ; Cancer ; Cancer patients ; Cancer research ; Care and treatment ; Community health care ; Complexity ; Data analysis ; Discharge ; Doctors ; Emergency medical care ; Emergency Medical Services ; Emergency Service, Hospital ; Feedback loops ; Female ; Health aspects ; Health care policy ; Health Personnel ; Hospital admission and discharge ; Hospitals ; Humans ; Information management ; Male ; Management ; Medical personnel ; Medical schools ; Medicine and Health Sciences ; Models, Theoretical ; Motor vehicle drivers ; Neoplasms - therapy ; Nurses ; Older people ; Palliative care ; Patient Discharge ; Patient safety ; Patients ; People and Places ; Physicians ; Primary care ; Secondary Care ; Self care (Health) ; Social aspects ; Systematic review</subject><ispartof>PloS one, 2019-05, Vol.14 (5), p.e0216430-e0216430</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Chen et al 2019 Chen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-d5c171e442c6b4716f4d0f0b669e8f480ea81418ef3b755e5c08d461036dcae93</citedby><cites>FETCH-LOGICAL-c692t-d5c171e442c6b4716f4d0f0b669e8f480ea81418ef3b755e5c08d461036dcae93</cites><orcidid>0000-0002-5596-6617 ; 0000-0002-5102-6302</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497383/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497383/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31048875$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Cheungpasitporn, Wisit</contributor><creatorcontrib>Chen, Hong</creatorcontrib><creatorcontrib>Walabyeki, Julie</creatorcontrib><creatorcontrib>Johnson, Miriam</creatorcontrib><creatorcontrib>Boland, Elaine</creatorcontrib><creatorcontrib>Seymour, Julie</creatorcontrib><creatorcontrib>Macleod, Una</creatorcontrib><title>An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care.</description><subject>Ambulatory Care</subject><subject>Analysis</subject><subject>Cancer</subject><subject>Cancer patients</subject><subject>Cancer research</subject><subject>Care and treatment</subject><subject>Community health care</subject><subject>Complexity</subject><subject>Data analysis</subject><subject>Discharge</subject><subject>Doctors</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services</subject><subject>Emergency Service, Hospital</subject><subject>Feedback loops</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health care policy</subject><subject>Health Personnel</subject><subject>Hospital admission and discharge</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Information management</subject><subject>Male</subject><subject>Management</subject><subject>Medical personnel</subject><subject>Medical schools</subject><subject>Medicine and Health Sciences</subject><subject>Models, Theoretical</subject><subject>Motor vehicle drivers</subject><subject>Neoplasms - therapy</subject><subject>Nurses</subject><subject>Older people</subject><subject>Palliative care</subject><subject>Patient Discharge</subject><subject>Patient safety</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Primary care</subject><subject>Secondary Care</subject><subject>Self care (Health)</subject><subject>Social aspects</subject><subject>Systematic review</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tu1DAQhiMEoqXwBggsIXG42MWOHcfhAqmqOFSqVHG8tbz2JOsqsYOdLO378WA4u2nVRb1AuUgy880_nhlPlj0leEloSd5e-DE41S5772CJc8IZxfeyQ1LRfMFzTO_f-j7IHsV4gXFBBecPswNKMBOiLA6zP8cOWTdAE9QABo3OQIiDcsa6BvkaDWtA2nd9C5fIBLtJ3skMHYQGnL5CfYAIblCD9S6iFIiU6WyM21_rkFZOQ0B9AhIW36Evo2rtxG8Add5A286pImjvjApXC60CoDWodlgnfV_DVk618RWCyx5CUtKwS7ax8Ds-zh7UyQtP5vdR9uPjh-8nnxdn559OT47PFppX-bAwhSYlAcZyzVesJLxmBtd4xXkFomYCgxKEEQE1XZVFAYXGwjBOMOVGK6joUfZ8p9u3Psp5AFHmOam4wHmVJ-J0RxivLmQfbJfqkV5ZuTX40EgVBqtbkLiiStFK8BTISp0LWkPOdFmtVlVN1aT1fs42rjowOrUvqHZPdN_j7Fo2fiM5q0oqaBJ4PQsE_2uEOMg0GJ0arhz4cTp3OjIrOJnQF_-gd1c3U41KBVhX-5RXT6LyuBAszwtaTl1a3kGlx0Bn04ihtsm-F_BmLyAxA1wOjRpjlKffvv4_e_5zn315i93dp-jbcXtV90G2A3XwMQaob5pMsJyW7bobclo2OS9bCnt2e0A3QdfbRf8CpyMpfA</recordid><startdate>20190502</startdate><enddate>20190502</enddate><creator>Chen, Hong</creator><creator>Walabyeki, Julie</creator><creator>Johnson, Miriam</creator><creator>Boland, Elaine</creator><creator>Seymour, Julie</creator><creator>Macleod, Una</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5596-6617</orcidid><orcidid>https://orcid.org/0000-0002-5102-6302</orcidid></search><sort><creationdate>20190502</creationdate><title>An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views</title><author>Chen, Hong ; Walabyeki, Julie ; Johnson, Miriam ; Boland, Elaine ; Seymour, Julie ; Macleod, Una</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-d5c171e442c6b4716f4d0f0b669e8f480ea81418ef3b755e5c08d461036dcae93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Ambulatory Care</topic><topic>Analysis</topic><topic>Cancer</topic><topic>Cancer patients</topic><topic>Cancer research</topic><topic>Care and treatment</topic><topic>Community health care</topic><topic>Complexity</topic><topic>Data analysis</topic><topic>Discharge</topic><topic>Doctors</topic><topic>Emergency medical care</topic><topic>Emergency Medical Services</topic><topic>Emergency Service, Hospital</topic><topic>Feedback loops</topic><topic>Female</topic><topic>Health aspects</topic><topic>Health care policy</topic><topic>Health Personnel</topic><topic>Hospital admission and discharge</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Information management</topic><topic>Male</topic><topic>Management</topic><topic>Medical personnel</topic><topic>Medical schools</topic><topic>Medicine and Health Sciences</topic><topic>Models, Theoretical</topic><topic>Motor vehicle drivers</topic><topic>Neoplasms - therapy</topic><topic>Nurses</topic><topic>Older people</topic><topic>Palliative care</topic><topic>Patient Discharge</topic><topic>Patient safety</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physicians</topic><topic>Primary care</topic><topic>Secondary Care</topic><topic>Self care (Health)</topic><topic>Social aspects</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Hong</creatorcontrib><creatorcontrib>Walabyeki, Julie</creatorcontrib><creatorcontrib>Johnson, Miriam</creatorcontrib><creatorcontrib>Boland, Elaine</creatorcontrib><creatorcontrib>Seymour, Julie</creatorcontrib><creatorcontrib>Macleod, Una</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Opposing Viewpoints Resource Center</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Advanced Technologies & Aerospace Database (1962 - current)</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>https://resources.nclive.org/materials</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agriculture Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Biological Science Journals</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest advanced technologies & aerospace journals</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials science collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Hong</au><au>Walabyeki, Julie</au><au>Johnson, Miriam</au><au>Boland, Elaine</au><au>Seymour, Julie</au><au>Macleod, Una</au><au>Cheungpasitporn, Wisit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-05-02</date><risdate>2019</risdate><volume>14</volume><issue>5</issue><spage>e0216430</spage><epage>e0216430</epage><pages>e0216430-e0216430</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31048875</pmid><doi>10.1371/journal.pone.0216430</doi><tpages>e0216430</tpages><orcidid>https://orcid.org/0000-0002-5596-6617</orcidid><orcidid>https://orcid.org/0000-0002-5102-6302</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-05, Vol.14 (5), p.e0216430-e0216430 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2219680292 |
| source | MEDLINE; Public Library of Science; Full-Text Journals in Chemistry (Open access); PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Ambulatory Care Analysis Cancer Cancer patients Cancer research Care and treatment Community health care Complexity Data analysis Discharge Doctors Emergency medical care Emergency Medical Services Emergency Service, Hospital Feedback loops Female Health aspects Health care policy Health Personnel Hospital admission and discharge Hospitals Humans Information management Male Management Medical personnel Medical schools Medicine and Health Sciences Models, Theoretical Motor vehicle drivers Neoplasms - therapy Nurses Older people Palliative care Patient Discharge Patient safety Patients People and Places Physicians Primary care Secondary Care Self care (Health) Social aspects Systematic review |
| title | An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T18%3A54%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=An%20integrated%20understanding%20of%20the%20complex%20drivers%20of%20emergency%20presentations%20and%20admissions%20in%20cancer%20patients:%20Qualitative%20modelling%20of%20secondary-care%20health%20professionals'%20experiences%20and%20views&rft.jtitle=PloS%20one&rft.au=Chen,%20Hong&rft.date=2019-05-02&rft.volume=14&rft.issue=5&rft.spage=e0216430&rft.epage=e0216430&rft.pages=e0216430-e0216430&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0216430&rft_dat=%3Cgale_plos_%3EA584225379%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2219680292&rft_id=info:pmid/31048875&rft_galeid=A584225379&rft_doaj_id=oai_doaj_org_article_093aa398602947c283fe24c79bb9f3a2&rfr_iscdi=true |