Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1G1.43 WMC 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
J.W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre 8440-112 Street NW, Edmonton, AB, T6G 2R7, Canada.
Support Care Cancer. 2020 Sep;28(9):4077-4094. doi: 10.1007/s00520-020-05490-1. Epub 2020 May 18.
The objective of this scoping review was to examine the effectiveness of supportive care interventions designed to reduce ED visits among patients receiving active cancer treatment.
Literature search involving nine electronic databases and grey literature. Inclusion criteria considered studies assessing the impact of any intervention to reduce ED utilization among patients with active cancer. Dichotomous and continuous outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model, wherever appropriate.
A total of 25 studies were included. Interventions identified in these studies comprised the following: routine and symptom-based patient follow-up, oncology outpatient clinics, early symptom detection, comprehensive inpatient management, hospital at home, and patient navigators. Six out of eight studies assessing oncology outpatient clinics reported a decrease in the proportion of patients presenting to the ED. A meta-analysis of three of these studies did not demonstrate reduction in ED utilization (RR 0.78; 95% CI 0.56 to 1.08; I = 77%) when comparing oncology outpatient clinics with standard care; however, sensitivity analysis supported a decrease in ED visits (RR 0.86; 95% CI 0.74 to 0.99; I = 47%). Three studies assessing patient follow-up interventions showed no difference in ED utilization (RR 0.69; 95% CI 0.38 to 1.25; I = 86%).
A variety of supportive care interventions designed to mitigate ED presentations by patients receiving active cancer treatment have been developed and evaluated. Limited evidence suggests that an oncology outpatient clinic may be an effective strategy to reduce ED utilization; however, additional high-quality studies are needed.
本范围综述的目的是研究旨在减少正在接受癌症积极治疗的患者急诊就诊的支持性护理干预措施的有效性。
涉及九个电子数据库和灰色文献的文献检索。纳入标准考虑了评估任何旨在减少正在接受癌症治疗的患者急诊就诊的干预措施的影响的研究。在适当的情况下，二分类和连续结局采用随机效应模型总结为风险比（RR）或均数差（MD）及其 95%置信区间（CI）。
共纳入 25 项研究。这些研究中确定的干预措施包括：常规和基于症状的患者随访、肿瘤门诊、早期症状检测、综合住院管理、家庭医院和患者导航员。评估肿瘤门诊的 8 项研究中有 6 项报告称，到急诊就诊的患者比例有所下降。对其中 3 项研究的荟萃分析表明，与标准护理相比，肿瘤门诊并未减少急诊就诊的利用（RR 0.78；95%CI 0.56 至 1.08；I = 77%）；然而，敏感性分析支持减少急诊就诊（RR 0.86；95%CI 0.74 至 0.99；I = 47%）。评估患者随访干预的 3 项研究显示，急诊就诊的利用无差异（RR 0.69；95%CI 0.38 至 1.25；I = 86%）。
已经开发和评估了多种旨在减轻正在接受癌症积极治疗的患者急诊就诊的支持性护理干预措施。有限的证据表明，肿瘤门诊可能是减少急诊就诊的有效策略；然而，需要更多高质量的研究。
