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Table 2 2021 workshop recommendations: research opportunities in cancer-related urgent and emergency care

From: Cancer-related emergency and urgent care: expanding the research agenda

ED utilization and prediction
 1. Establish standard definitions and measures of preventable or avoidable oncology-related urgent care and ED visits.
 2. Establish consistent methodologies to study ED utilization for cancer care.
 3. Characterize individual, system, and societal drivers of unscheduled cancer-related medical care (e.g., reasons for visit, rural versus urban settings, socioeconomic).
 4. Characterize individual, system, and societal drivers of new cancer diagnoses identified in the ED setting.
 5. Develop predictive models to identify those at high risk for unscheduled cancer care based on manageable or modifiable factors.
 6. Create data linkages among existing sources to address utilization and risk prediction knowledge gaps (e.g., EHR, claims/administrative data, PRO).
 7. Utilize technologies, such as natural language processing, to enhance capture of meaningful and actionable data from registry and EHR that are relevant to managing unscheduled cancer care visits.
 8. Conduct large, prospective observational studies with detailed information on patient symptoms, cancer history, treatment history, unscheduled care management interventions, outcomes, and disposition to characterize utilization of urgent and emergent care across care settings.
Care delivery models and strategies
 9. Identify and test existing and novel oncology and emergency medicine healthcare models to evaluate their impact on unscheduled cancer care prevention, management, care coordination, and patient outcomes, including effectiveness, cost, and patient acceptability.
 10. Characterize pre-, peri-, and post-pandemic urgent and emergent care use, prevention and management strategies, and outcomes for cancer-related needs.
 11. Develop and test modifiable risk factor reduction interventions such as telemedicine, remote home monitoring, and PRO measures across various settings and populations.
 12. Test and validate the use of artificial intelligence and machine learning for cancer-related symptom monitoring and management in the outpatient oncology setting to identify and intervene before they become severe or uncontrolled.
 13. Employ standard measures to better characterize outcome and cost of oncology, urgent, and emergency care delivery models.
 14. Characterize the impact of specialty knowledge and resources that improve cancer outcomes in urgent and emergency care settings (e.g., oncology providers in the ED).
Cancer prevention and screening in ED
 15. Characterize the population who is relying on the ED for planned care and may most benefit from cancer prevention and screening services.
 16. Develop and test strategies to increase cancer screening uptake in the ED while accounting for competing resources.
 17. Develop, test, and implement information technology solutions to identify ED patients that should be offered cancer screening and follow-up.
 18. Identify the barriers to cancer screening and prevention referrals and follow-up post ED visit and test strategies to improve outcomes, considering different resource and care settings.
Managing cancer-related presentations in urgent care and the ED
Risk stratification in ED
  19. Develop and validate new ED-oncology-specific risk stratification tools for severity of presentation, resource utilization, and disposition (e.g., for neutropenic fever, pulmonary embolism, immune-related adverse events).
  20. Develop, test, and adopt clinically viable and sustainable biomarkers and rapid diagnostics to risk stratify patients presenting with oncologic emergencies.
  21. Develop effective quick assessment tools using EHR data for cancer patient triage and care delivery in urgent and emergent care settings.
Clinical pathways
  22. Integrate existing and new cancer symptom and adverse event management evidence into emergency medicine accelerated pathways and test effectiveness and implementation across settings and populations.
  23. Determine which care pathways are generalizable and scalable across care settings and populations.
  24. Create efficient communication pathways for smaller ED to access resource rich care systems.
  25. Study and compare costs and efficiencies across care settings, including behavioral economics, identification of CPT codes that will be/will not be reimbursed, duplication of imaging studies, laboratory tests, etc.
Disposition
  26. Identify individual, system, and societal factors associated with hospitalization after a cancer-related ED visit.
  27. Develop and test strategies to improve post-urgent and emergency follow-up care and communication.
  28. Examine methods to improve interoperability of medical record sharing between specialty care settings (e.g., oncology, emergency medicine) and institutions (e.g., academic, community) to support decision making and follow-up care for unscheduled cancer care.
Cancer-related goals of care in the ED
 29. Characterize the unmet palliative care or end-of-life needs of cancer patients utilizing emergency care services.
 30. Develop, test, and adopt symptom management assessment tools to identify patients with cancer that may benefit from palliative care referrals for management of symptoms, care support, and/or goals of care conversations (e.g., PCaRES — facilitated assessment of eligibility for palliative care when in the ED)
 31. Develop, test, and implement interventions to communicate and meet individual goals of care and minimize urgent and emergent care needs (e.g., offer hospice services, palliative care services).
 32. Integrate palliative care into clinical trials in advanced cancer patients.
 33. Test various care coordination and navigation strategies post-urgent care or ED visit to identify barriers and facilitators to improve outcomes.
Designing and conducting oncologic emergency research studies
 34. Leverage prior ED research methods for other diseases/symptoms (e.g., cardiovascular events) to develop, test, and implement oncology specific care pathways.
 35. Engage urgent care, emergency medicine, oncology, primary care, clinical care team members, informatics, patients, advocacy groups, community partners, and other key stakeholders in cancer-related urgent and emergency care study design to enhance the translation of study findings and improve application to diverse populations and settings.
 36. Assess existing oncologic emergency research fellowships to identify facilitators to success and identify opportunities to expand mentor opportunities across programs.
 37. Promote more standardized EHR data collection for oncology patient encounters in the emergency care setting.
 38. Develop standard cancer ED visit data collection elements for observation and intervention studies to promote consistent assessment parameters and outcome measurement.
 39. Identify, assess, and integrate evolving evidence into practice guidelines with an initial focus on high-risk and high-frequency symptom presentations, considering the resource variability of urgent and emergent care settings.
  1. ED Emergency department, PRO Patient-reported outcome, EHR Electronic health record, CPT Current procedural terminology, PCaRES Palliative care screening