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“I’ll be in a safe place”: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care
  1. Lesley A Henson1,
  2. Irene J Higginson1,
  3. Barbara A Daveson1,
  4. Clare Ellis-Smith1,
  5. Jonathan Koffman1,
  6. Myfanwy Morgan2,
  7. Wei Gao1,
  8. on behalf of BuildCARE
  1. 1King’s College London, Faculty of Life Sciences and Medicine, Division of Palliative Care, Policy and Rehabilitation, UK
  2. 2King’s College London, Faculty of Life Sciences and Medicine, Division of Health and Social Care Research, UK


Objective To explore the decisions of people with advanced cancer, and their caregivers, to seek emergency department (ED) care, and understand the issues that influence the decision-making process.

Design Qualitative study incorporating semi-structured patient and caregiver interviews, plus research field notes.

Methods Between December 2014 and July 2015, semi-structured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers. Interviews were audio-recorded, transcribed verbatim and analysed using a constant comparative approach. Padgett and Brodsky’s modified version of the “Model of Health Services Use” was used as a framework for the study.1

Results Issues influencing the decision-making process included: i) Anxiety relating to having a diagnosis of cancer – those with greater anxiety interpreted symptoms as more severe and/or requiring immediate attention; ii) Prior patterns of health-seeking behaviour – at times of crisis participants defaulted to previously used services; iii) Feelings of safety and familiarity with the hospital setting – many felt reassured by the presence of healthcare professionals and monitoring of their condition; and, iv) Difficulties accessing community healthcare services – especially urgently and/or out-of-hours.

Conclusion These data provide healthcare professionals and policymakers with a greater understanding of how systems of care may be developed to help reduce end-of-life ED visits. In particular, our findings suggest that greater support and education regarding end-of-life symptoms, earlier collaboration between oncology and palliative care and increased access to community healthcare services may help reduce the number of end-of-life ED visits made by people with advanced cancer.


  1. Padgett DK, Brodsky B.Psychosocial factors influencing nonurgent use of the emergency room – a review of the literature and recommendations for research and improved service delivery. Soc Sci Med 1992;35(9):1189–1197

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