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21 November 2012
Emergency admissions for patients with cancer remain problematic despite the development of acute oncology. There is more that could be done to improve their care and subsequent experiences and outcomes.
Patients and their carers often have a lack of information about what to expect and who to contact when their condition suddenly worsens and requires urgent medical attention – this is often referred to as a crisis. Cancer management is complex and involves a number of teams and there has been little emphasis on planning for potential problems. More proactive care would ensure that patients, their carers and health professionals are better equipped to respond when a person becomes acutely unwell.
When admitted to hospital there is a need to improve decision-making, coordination of care and communication between professionals and – crucially – with patients themselves. In unplanned and urgent situations, patients themselves may receive confusing or conflicting information or feel less able to assert their concerns and wishes. Too often patients receive fragmented care. Patients are often seen by multiple healthcare professionals and sometimes multiple medical specialties during an admission.
This results in some patients being treated suboptimally, especially where the cancer diagnosis clouds other considerations in their management. Others, especially nearing the end of life, may undergo repeated investigations and interventions that are not to their benefit. Some admissions, especially among patients already approaching the end of life, may be avoidable.1
This new report Cancer patients in crisis: responding to urgent needs from the Royal College of Physicians (RCP) and Royal College of Radiologists (RCR), including a foreword from Professor Sir Mike Richards, national clinical director for cancer, provides decision making tools to health professionals working in hospitals and the community, to help improve the care of cancer patients in crisis. It also proposes standards of good practice in each care setting which should reduce risk and improve outcomes.
Patient and carer representative members of the working party have led on the development of an innovative planning wallet for patients. This is intended to encourage timely discussions about unexpected problems at any point in a patient’s journey. It will prompt patients to seek and keep to hand important information and help to facilitate forward planning regarding their care.
Dr Wendy Makin, chair of the RCP-RCR joint working party and consultant in palliative care and oncology said:
This report offers recommendations to health professionals, commissioners and policy makers that will help to improve the care given to cancer patients. It also it provides tools to patients to help them and their carers take charge of their treatment and improve the care they receive.
Dr Linda Patterson, RCP clinical vice president, said:
The care of cancer patients has greatly improved over the past 20 years however there is more to be done to facilitate shared decision making enable continuity of care and improve quality. I urge all clinicians and health professions to make use of the decision making aids and promote the use of the wallet with your patients. These can save precious time and permit sound clinical decision making.
Dr Jane Barrett, president of the RCR, said:
Patient care and joint decision making must be at the centre of cancer services now and in the future. As clinical oncologists an important part of our role is to ensure that a patient understands their treatment and able to decide what is best for them, cancer treatment cannot be a one-sided process. This report gives healthcare professionals recommendations to provide the best care and patients the tools to play an active role in the decisions made about their care.
For more information please contact Lisa Cunningham, public affairs manager at the RCP:
020 3075 1468
Notes for editors
can download the full report, patient wallet and decision making aids for
health professionals in hospitals and community settings by visiting the Cancer patients in crisis webpage.
Cancer patients in crisis: responding to urgent needs has been written with wide
representation form nursing, primary care, critical care medicine as well as
acute medical specialties and oncology and patient representation.
The following evidence was cited in the press release:
- Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ 2010;182:563–8