Understanding drivers of emergency department visits among patients from populations disproportionately affected by acute care use during cancer treatment: insights from qualitative interviews

PURPOSE: Emergency department (ED) visits are frequent during cancer treatment, burdensome for patients and caregivers, and disproportionately affect those from marginalized groups. While many such events may be preventable, rates in practice remain stubbornly high, and patient perspectives on the drivers of ED use remain underexplored, particularly among marginalized patients. METHODS: Within a quality improvement initiative aimed at reducing sociodemographic disparities in ED use, we conducted semi-structured interviews with adults receiving systemic anticancer therapy at a large academic medical center. Eligible participants were from marginalized populations with an ED visit within 30 days of treatment. Interviews explored symptom experiences, care-seeking decisions, and perceived barriers to outpatient support. Transcripts were analyzed using iterative thematic analysis to identify pathways to and underlying causes of ED presentation. RESULTS: Among 11 eligible patients approached, 10 participated, all of whom were Black and/or Medicaid insured. Two pathways to ED presentation were identified: self-referral and referral by a health care professional. Underlying ED visit drivers, namely symptom onset or escalation accompanied by worry and uncertainty, barriers to accessing trusted clinical advice between visits, and limited effective self-management strategies, were consistent across pathways. Patients normalized treatment-related symptoms, relied on improvised self-management strategies, and sought guidance from informal advice networks, including family members and peers, which shaped their care-seeking decisions. CONCLUSIONS: Patient interviews revealed multiple, interrelated drivers of ED use during cancer treatment that extend beyond symptom severity alone. Findings identified multiple targets for improved supportive care processes and strategies to reduce preventable ED visits during cancer treatment.