What Makes an Emergency Visit ‘Avoidable’? A Qualitative Systematic Review of Multidisciplinary Clinician Perspectives on Acute Oncology Care Delivery

Background Emergency department (ED) presentations by patients with cancer are increasing globally. Policy frameworks often classify these as “potentially preventable emergency department visits” (PPEDVs) using administrative coding, yet the validity of this approach is contested. No qualitative systematic review of clinician perspectives on avoidable oncology ED use currently exists. Objective To synthesise multidisciplinary clinician perspectives on avoidable ED use in oncology and identify the barriers and facilitators that must be addressed to support alternatives to emergency attendance. Methods We searched CINAHL, PsycINFO, PubMed, and Scopus from inception to April 2026 for qualitative studies on clinician perceptions of avoidable oncology ED use. Data from 7 included studies (n = 180 clinicians) were synthesised using a three-stage thematic synthesis approach. Quality was assessed using the CASP Qualitative Checklist and GRADE-CERQual. Results Four analytical constructs were identified: (1) professional risk aversion under diagnostic uncertainty makes ED escalation a rational choice; (2) fractured communication across professional silos acts as a structural driver of attendance; (3) the ED serves as an organisational proxy for inaccessible 24/7 specialist care; and (4) clinicians contest policy-based definitions of “avoidability,” particularly at the end of life. Conclusions Avoidable ED use in oncology is primarily a product of system failures rather than clinical misuse. Reducing these visits requires concurrent investment in 24/7 specialist-led pathways, shared information infrastructure, anticipatory patient guidance, cross-specialty training, and accountable care coordination models.