Barriers to Recruiting ED Patients With Advanced Cancer for Palliative Care

Surabhi Dangi-Garimella, PhD

Patient refusal, symptom burden, and diagnostic disparities were identified as some of the most common barriers encountered when recruiting patients with advanced cancer for palliative treatment in the emergency department (ED).
Several factors regarding the ED setting can preclude use of palliative care services, including the fact that patients and families that check into an ED usually do so because they are highly stressed. Recruiting advanced cancer patients in this setting may be important, considering that vital decisions on intensity of care or using life-prolonging treatment may be made in these patients.
In this prospective study, published in The Journal of Community and Supportive Oncology, authors recruited patients who presented at the ED of the study hospital over an 18-month period starting June 2011. Eligibility criteria included: Prior to research staff inviting the patients to enroll on the study, approval from the ED attending was required and the patient’s medical oncologist had to agree. Patients were offered a $20 incentive to participate in the study.
The authors could only enroll 73 patients, instead of the target 150 (49% enrollment rate)—77 patients did not participate because of the following barriers: The authors conclude that the barriers they noted mirror those observed with palliative care enrollment in other healthcare settings. These previous studies, the authors note, recommend using adaptive approaches for recruitment, including: The authors of the current study propose the development of specific strategies to overcome physician and family barriers, training non-clinical staff to overcome ED-specific recruitment obstacles, and broadening trial inclusion criteria as a way forward.
Print | AJMC Printing...