What patient education is appropriate for a patient diagnosed with metastatic cancer in the emergency department (ED)?

From the Guidelines

Patient education for someone diagnosed with metastatic cancer in the emergency department should prioritize providing information and support to address their immediate needs and concerns, including normalcy of stress, sources of informational support, and specific strategies for managing stress, fatigue, and sleep problems, as outlined in the most recent guidelines 1. When educating patients with metastatic cancer, it is essential to consider their emotional and psychological well-being, as they often experience anxiety, depression, and stress. The patient should be informed about their diagnosis in clear, compassionate terms, explaining that cancer has spread beyond its original site to other parts of the body. Key aspects of patient education should include:

• Normalcy of stress in the context of cancer
• Sources of informational support/resources regarding disease/treatment
• Specific information/strategies for managing stress, fatigue, and sleep problems, such as progressive muscle relaxation, cognitive behavioral therapy for insomnia (CBTi), and nutrition/dietary support services
• Information about anticipated treatment costs and availability of financial guidance and support services
• Resources for emotional support, including hospital social workers, cancer support groups, and counseling services, as patients with depressive symptoms may lack motivation to follow through on referrals or comply with treatment recommendations 1. It is also crucial to assess the patient's symptoms and follow-through with referrals and treatment recommendations regularly, ideally on a biweekly or monthly basis, until symptoms have remitted 1. While advance care planning is an essential process that should begin at the time of diagnosis, the initial focus in the emergency department should be on providing immediate support and education to help the patient navigate their diagnosis and treatment options 1.

From the Research

Patient Education for Metastatic Cancer in the Emergency Department

• Patient education for metastatic cancer in the emergency department (ED) should focus on symptom management, treatment options, and palliative care 2.
• Patients with metastatic bone cancer, for example, require education on pain management and psychological support 2.
• Education on the signs and symptoms of metastatic cancer, such as bone metastases, can help patients recognize when to seek medical attention 2.
• Patients diagnosed with cancer in the ED often have advanced or metastatic disease, and may require immediate attention to their physical and psychological needs 3, 4.
• Timely evidence-based decisions in the ED regarding diagnostic testing, medications, and disposition can significantly improve a cancer patient's quality of life 5.
• Patient education should also address the importance of multidisciplinary collaboration in the ED, including oncologists, geriatricians, and palliative care specialists, to improve patient outcomes 3.
• Additionally, patients who have received palliative radiation therapy may require education on end-of-life treatment preferences and goals of care 6.