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Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis
  1. Sarah E E Mills1,
  2. Louise J Geneen2,
  3. Deans Buchanan3,
  4. Bruce Guthrie4 and
  5. Blair H Smith1
  1. 1 Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  2. 2 Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
  3. 3 Palliative Medicine & Supportive Care, NHS Tayside, Dundee, UK
  4. 4 College of Medicine and Veterinary Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  1. Correspondence to Dr Sarah E E Mills, University of Dundee College of Medicine Dentistry and Nursing, Dundee DD2 4BF, UK; s.e.e.mills{at}


Background People who die from cancer (cancer decedents) may experience unpleasant and distressing symptoms which cause them to present to unscheduled care. Unscheduled care is unplanned care delivered by general practitioner out-of-hours and emergency departments. Use of unscheduled care can disrupt treatment plans, leading to a disjointed patient care and suboptimal outcomes.

Objectives This systematic review aimed to identify factors associated with unscheduled care use by cancer decedents.

Method Systematic review with narrative synthesis of seven electronic databases (PubMed; Medline; Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Web of Science; Cumulative Index to Nursing and Allied Health Literature) from inception until 01 January 2020. All observational and experimental studies were included, irrespective of their research design.

Results The search yielded 238 publications included at full-text, of which 47 were included in the final review and synthesis. Unscheduled care use by cancer decedents was influenced by multiple factors, synthesised into themes: demography, clinical and patient, temporal, prescribing and systems. Cancer decedents who were older, men, had comorbidities, or lung cancer, were most likely to use unscheduled care. Unscheduled care presentations were commonly due to pain, breathlessness and gastrointestinal symptoms. Low continuity of care, and oncology-led care were associated with greater unscheduled care use. Access to palliative care, having an up-to-date palliative care plan, and carer education were associated with less unscheduled care use.

Conclusion The review identifies multiple factors associated with unscheduled care use by cancer decedents. Understanding these factors can inform future practice and policy developments, in order to appropriately target future interventions, optimise service delivery and improve the patient journey.

PROSPERO registration number CRD42016047231.

  • cancer
  • end of life care
  • quality of life
  • terminal care

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  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Contributors All authors are aware of and agree to the submission and that have all contributed this manuscript sufficiently to be named as authors. All persons or bodies with an interest in this manuscript are aware of its submission and agree to it.

  • Funding SEEM was funded by a Clinical Academic Fellowship through the Chief Scientist Office (reference number: CAF_17_06) and the Claire Wand Fund.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.