Patient Factors That Drive Unplanned Acute Care Utilization In Oncology Care.

e18011 Background: There is a critical need to develop oncology care delivery models that help cancer patients avoid preventable acute hospital care. We are conducting a mixed methods study to assess patient- provider- and system-level factors that drive unplanned acute care utilization in order to implement evidence-based practices (EBPs) at a large health system. Here we present data from patient perspectives on the factors that influence their decision to seek acute care. Methods: We used a purposive sampling approach to identify cancer patients with solid tumors on active treatment with unplanned acute care events at an academic cancer center or its two affiliated community practices from August 2018-January 2019. We conducted semi-structured interviews designed to elicit patient factors that drive unplanned acute care utilization and to understand strategies patients use to manage unexpected symptoms at home. Interviews were analyzed using the constant comparative method to identify key themes. Results: Forty-three patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ sense of guilt for burdening their oncology team and to differences in provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED. However, due to safety concerns, patients do prefer in-person evaluation for new and distressing symptoms. They also express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care and identify the following targets for implementation of EBPs: 1) symptom management 2) provider accessibility 3) alternate triage pathways for in-person evaluation. Strategies to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.