Review question:1.What interventions have been tested and have successfully reduced unplanned hospital admissions in adults with cancer?2.What are the factors associated with unplanned hospital admissions in adults with cancer

Allgar, Victoria

Chen, Hong

Dyson, Judith

Hammond, Thomas

Johnson, Miriam

Macleod, Una

Oliver, Steven

Oviasu, Osaretin

Smith, Sarah

Walabyeki, Julie

English

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 PROSPEROInternational prospective register of systematic reviews A systematic review examining reducing unplanned hospital admissions inadults with cancerJulie Walabyeki, Una Macleod, Miriam Johnson, Judith Dyson, Steven Oliver, Victoria Allgar, OsaretinOviasu, Hong Chen, Sarah Smith, Thomas HammondCitationJulie Walabyeki, Una Macleod, Miriam Johnson, Judith Dyson, Steven Oliver, Victoria Allgar, OsaretinOviasu, Hong Chen, Sarah Smith, Thomas Hammond. A systematic review examining reducing unplannedhospital admissions in adults with cancer. PROSPERO 2017 CRD42017055233 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017055233Review question1. What interventions have been tested and have successfully reduced unplanned hospital admissions inadults with cancer?2. What are the factors associated with unplanned hospital admissions in adults with cancer?SearchesThe search strategy will comprise MeSH terms and free text, and we will search the following bibliographicdatabases: MEDLINE, EMBASE, Scopus, PsycINFO, The Cochrane Library, PubMed and Web of Science. Experts in the field will be contacted to identify additional references, the grey literature and reference listswill be searched (pearling), and we will also hand search the bibliographies. Only English language papers will be eligible for inclusion, published from 1946 to date. The searches will be re-run just before the final analyses and further studies retrieved for inclusion.Types of study to be includedAny study design will be included, e.g. qualitative, quantitative or mixed designs. Studies will not be excludedon the basis of the quality of their reported methods.Condition or domain being studiedUnplanned hospital admissions are important globally because they burden health service delivery (WHO2008; Comptroller & Auditor General 2013); may lead to the patient getting hospital-acquired infections(Magill et al 2014) and tend to reduce bed availability which in turn may led to longer waiting times forelective procedures, which is expensive (Purdy et al 2012). An unplanned hospital admission has beenregarded as an unexpected admission or readmission to hospital in-patient status that occurs at short noticebecause of an alleged need for immediate healthcare (Bobrovitz et al 2015). Previous systematic reviewshave focused on other conditions and older people (Purdy et al 2012; Huntley et al 2016; Green et al 2016)and have not specifically focused on cancer. Previous research has suggested that most unplanned hospitaladmissions are cancer-related (Gibson and McConigley 2015) and not therapy-related (Brunetto et al 2010).Patients with respiratory symptoms, particularly those with lung cancer, gastro-intestinal symptoms and painwere most likely to have unplanned hospital admission although these symptoms may be managed withinthe community (Hjermstad et al 2013; Green et al 2016). In order to reduce hospital acquired infectionsamong people with cancer and also to increase bed availability which in turn reduces the burden on thehealthcare service, interventions to reduce unplanned hospital admissions ought to be developed. It istherefore essential to explore the issues pertaining to reducing unplanned hospital admissions in adults with                               Page: 1 / 6 PROSPEROInternational prospective register of systematic reviewscancer. We intend to conduct a systematic review to explore the factors associated with unplanned hospitaladmissions and the successful interventions that have been tested in adults with cancer. We hope ourfindings will contribute to the development of an intervention to reduce unplanned hospital admissions inadults with cancer. References:Bobrovitz, N., Onakpoya, I., Roberts, N., Heneghan, C. and Mahtani, K.R., 2015. Protocol for an overview ofsystematic reviews of interventions to reduce unscheduled hospital admissions among adults. BMJ Open,5(8). Brunetto, A.T., Ang, J.E., Olmos, D., Tan, D., Barriuso, J., Arkenau, H., Yap, T.A., Molife, L.R., Banerji, U.,De Bono, J., Judson, I. and Kaye, S., 2010. A study of the pattern of hospital admissions in a specialistPhase I oncology trials unit: Unplanned admissions as an early indicator of patient attrition. European journalof cancer, 46(15), pp. 2739-2745. Comptroller. and Auditor General., 2013. Emergency admissions to hospital: managing the demand. HC 739.London: National Audit Office, TSO.Gibson, S. and McConigley, R., 2016. Unplanned oncology admissions within 14 days of non-surgicaldischarge: a retrospective study. Supportive Care in Cancer, 24(1), pp. 311-317. Green, E., Gott, M. and Wong, J., 2016. Why do adults with palliative care needs present to the emergencydepartment? A narrative review of the literature. Progress in Palliative Care, 24(4), pp. 195-203. Hjermstad, M.J., Kolflaath, J., Lokken, A.O., Hanssen, S.B., Normann, A.P. and Aass, N., 2013. Areemergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJopen, 3(5), pp. 10.1136/bmjopen-2012-002515Huntley, A.L., Johnson, R., King, A., Morris, R.W. and Purdy, S., 2016. Does case management for patientswith heart failure based in the community reduce unplanned hospital admissions? A systematic review andmeta-analysis. BMJ Open, 6(5),. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J (2014) Multistate point-prevalence survey of health care–associated infections. N Engl JMed 370: 1198-1208 Purdy S, Paranjothy S, Huntley A, Thomas R, Mann M, Huws D, Brindle P, Elwyn G (2012) Interventions toreduce unplanned hospital admission: a series of systematic reviews. National Institute for Health Research;Research for Patient Benefit no. PB-PG-1208-18013 WHO., 2008. The World Health Report 2008-Primary Health Care (Now More Than Ever). Geneva: WHO.Participants/populationPatient group: studies of adults over 18 years of age, diagnosed with cancer.Intervention(s), exposure(s)All studies which examine: • Any intervention aiming to reduce unplanned admissions;• Factors which could be related to unplanned hospital admissions.                               Page: 2 / 6 PROSPEROInternational prospective register of systematic reviewsComparator(s)/controlNot applicable.ContextInclusion criteria:Population: adults over 18 years old with a confirmed diagnosis of cancer.Exposure: any intervention aiming to reduce unplanned admission; factors which could be related tounplanned hospital admission.Outcome: studies about unplanned hospital admissions.Exclusion criteria: Population: studies of people with suspected cancer but no confirmed cancer diagnosis; people with a non-cancer diagnosis.Outcome: studies about planned admissions.Limits: only English language papers will be included, with no time limits (but possibly from 1946 to date).Primary outcome(s)Unplanned hospital admissions.Timing and effect measuresNot applicable.Secondary outcome(s)None.Timing and effect measuresNot applicable.Data extraction (selection and coding)Study selection:• Two reviewers will independently sift the titles and abstracts of studies and note those that they considermeet our inclusion criteria. Differences will be reconciled, with a third reviewer, if necessary. • Two reviewers will independently consider the full text papers against the inclusion criteria, with a thirdreviewer, if necessary. Excluded studies will be recorded in a table, together with the reason(s) for exclusion.• Multiple reports from the same study will be collated, and authors contacted if necessary for clarification.                                Page: 3 / 6 PROSPEROInternational prospective register of systematic reviews• Decisions relating to recording and summarising during study selection will be recorded in a flow diagram.Data extraction:• The primary reviewer will extract data and details from all the included studies. Depending upon thenumber of articles retrieved, one or more secondary reviewers will independently extract 10%-20%. • Two reviewers will compare results. Disagreements will be resolved by discussion or by referral to a thirdreviewer if necessary.• We aim to extract raw data if possible, i.e., raw numbers rather than percentages or measures of effect. • If data is reported in serial or duplicate publications, the primary data set will only be used once. • We will contact the authors for further information if studies are only available as abstracts or if there ismissing data or details.• The extraction form will be piloted on the first two to three papers, and adjustments made with theconsensus of all of the reviewers.Risk of bias (quality) assessmentTwo reviewers will independently assess the methodological quality of each study by using one of thevalidated quality assessment tools for systematic reviews. Discrepancies in the ratings of the methodologicalreviews or in the ratings of the quality of evidence will be resolved by consensus between the authors and, ifnecessary, mediation by a third author. Depending upon the number of articles retrieved, one or moresecondary reviewers will independently assess 10%-20%. Their judgements will be compared, anddisagreements reconciled.Strategy for data synthesisResults will be analysed in accordance with the guidelines in the Preferred Reporting Items for SystematicReviews and Meta-Analysis (PRISMA) statement (Moher et al 2009), and a PRISMA flow diagram will beused to summarise study selection. We will conduct a meta-analysis on ‘reduced unplanned hospitaladmissions of people with cancer’ comparing the intervention and the control groups, and we will alsoconduct subgroup analyses (see next section). If it is not possible to conduct a meta-analysis, we willdescribe the summary of the included studies using a narrative approach while drawing on the theoreticaldomain framework (Cane et al 2012) and the behaviour change wheel (Michie et al 2011). A preliminarysynthesis of the findings of the included studies will be conducted, to explore the relationships within andbetween the studies and to assess the robustness of the synthesis.Potential limitations: there is the possibility that relevant studies may be overlooked despite using robustsearch strategies in multiple databases with no language or time restrictions.Analysis of subgroups or subsetsWe will explore subgroup analyses to investigate which interventions most effectively reduce admissionsamong cancer patients. The sub-groups will include: Age groups;                                Page: 4 / 6 PROSPEROInternational prospective register of systematic reviewsGender; Social economic status (SES if present); Survival of patients by:- Type of referral: by direct emergency or GP referrals; - Residence: either from patients' homes or from care homes;- Admission reason: either medical reasons or social reasons for admissions and by cancer types.Contact details for further informationJulie WalabyekiJulie.Walabyeki@hyms.ac.ukOrganisational affiliation of the reviewHull York Medical School, University of HullReview team members and their organisational affiliationsDr Julie Walabyeki. Hull York Medical School, University of HullProfessor Una Macleod. Hull York Medical School, University of HullProfessor Miriam Johnson. Hull York Medical School, University of HullDr Judith Dyson. Hull York Medical School, University of HullDr Steven Oliver. Hull York Medical School, University of YorkDr Victoria Allgar. Hull York Medical School, University of YorkDr Osaretin Oviasu. Hull York Medical School, University of HullDr Hong Chen. Hull York Medical School, University of HullMs Sarah Smith. Hull York Medical School, University of HullMr Thomas Hammond. Hull York Medical School, University of HullAnticipated or actual start date17 January 2017Anticipated completion date31 August 2017Funding sources/sponsorsYorkshire Cancer Research, University of Hull Endowment Fund-Programme Award HEND001Conflicts of interestNone knownLanguageEnglish                               Page: 5 / 6 PROSPEROInternational prospective register of systematic reviewsCountryEnglandPROSPEROThis information has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registrationrecord, any associated files or external websites. 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A systematic review examining reducing unplanned hospital admissions in adults with cancer

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A systematic review examining reducing unplanned hospital admissions in adults with cancer

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