Agreement Between Emergency Physicians and Intensivists in the Clinical Management of Patients with Oncologic Emergencies: A Comparative Study of Attitudes and Therapeutic Decision-Making.

• Grant number: 25/04289-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: June 01, 2025
• End date: December 31, 2025
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Lucas Leite Cunha
• Grantee: Ana Carolina Zacharias de Oliveira
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

The care of patients with oncological emergencies requires rapid and coordinated decisions among various healthcare professionals, with a particular emphasis on the involvement of emergency and intensive care physicians. However, differences in training and clinical approaches between these two groups of professionals can lead to discrepancies in decision-making, especially in critical situations involving the limitation of life support. This study aims to evaluate the degree of agreement between emergency and intensive care physicians in the management of oncological emergencies, to identify patterns of divergence, and to propose strategies for the harmonization of practices. Specifically, the study seeks to assess whether there are disagreements in three particular situations: the management of moderately severe cases; therapeutic limitations in end-of-life patients; and approaches to critically ill patients. This will be a cross-sectional observational study, collecting opinions through structured questionnaires administered to 100 participants (50 emergency physicians and 50 intensive care physicians) from the A.C. Camargo Cancer Center and Hospital São Paulo. Three hypothetical clinical scenarios will be presented, and the responses will be analyzed both quantitatively and qualitatively, using Cohen's Kappa coefficient to measure the degree of agreement. The study aims to identify significant differences between emergency and intensive care physicians regarding the indication of invasive interventions, therapeutic limitations, and the management of critical cases. The findings may support the creation of standardized protocols and the improvement of interdisciplinary communication, with the goal of enhancing the quality of care for patients with oncological emergencies. In this way, the study may contribute to optimizing oncological emergency care by reducing discrepancies in clinical practice and promoting greater integration between specialties, ensuring that decisions are more aligned with the needs of patients and their families.