Management of patients on chemotherapeutic treatment for advanced cancer with acute conditions in the Emergency Department

Chemotherapy is increasingly used in people with advanced cancer, with the aim to palliate symptoms and to improve survival. Patients may live longer but quality of life may be affected by treatment-related events. New Zealand provides medical oncology services in a Hub and Spoke model, with an increasing emphasis on delivering treatment at out-patient ‘satellite’ services. The reality is that these services do not provide around the clock care, so after hours and urgent care is provided by the local Emergency Department (ED). There is evidence to suggest cancer patients on chemotherapy are clinically high risk, presenting more frequently to the ED and with more complex clinical needs than the general population. This study sought to answer the question “How do ED nurses manage patients on chemotherapeutic treatment for advanced cancer presenting with acute conditions?” The research objectives were to explore the factors that influence clinical decision-making and nursing care provision to this group of patients. A qualitative, exploratory study was undertaken. A voluntary, purposive sample of 5 ED nurses from three satellite hospitals underwent semi-structured telephone interviews, each lasting from 30-40 minutes. The interviews were transcribed and the raw data thematically analysed via an exploratory descriptive approach. Analysis yielded three main categories: Context, Communication and Collaboration, and Awareness. Care delivered within the context of the ED is presentation-driven and urgency-driven. Chemotherapy treatment and goals of care may have little influence on the interventions provided. Challenges arise through patient complexity, lack of oncology specialist availability and low volumes that preclude the maintenance of specialist skills and knowledge. Care may be more influenced by local Hospice teams due to well established relationships with the ED. A more collaborative relationship between Oncology and the ED may be the key to future models of care that support ED staff to provide acute and emergency care within the context of the patient’s disease, their chemotherapy and their goals of active treatment.

Name thesis:degree_name

Master of Nursing

Level thesis:degree_level

Masters

Grantor

Eastern Institute of Technology

Year dc:date.issued

2013

Author dc:creator

• Gray, Lynne

• New Zealand
• emergency nurses
• emergency departments (EDs)
• satellite sites
• cancer patients
• Māori
• chemotherapy
• acute conditions
• clinical decision-making
• care
• interviews

Statement dc:rights

• All rights reserved

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10652/6457

OAI identifier oai:identifier

oai:null:10652/6457