Tensions and contradictions - A qualitative study exploring the experience of health professionals caring for patients with advanced cancer in the emergency department — ASN Events
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Tensions and contradictions - A qualitative study exploring the experience of health professionals caring for patients with advanced cancer in the emergency department (#719)

Jennifer Weil 1 , Jennifer Philip 1 2 , Heather Lane 1 2 , Tracey Weiland 3 , Claudia Marck 3 , Mark Boughey 1 2 , George Jelinek 3
  1. St Vincent's Hospital Melbourne, Fitzroy, Vic, Australia
  2. Centre for Palliative Care, St Vincent's Hospital and University of Melbourne, Fitzroy, Vic, Australia
  3. Emergency Practice and Innovation Centre, St Vincent's Hospital, Fitzroy, Vic, Australia

Aims: People with advanced cancer often present to hospital emergency departments (ED’s).
This study sought to understand the views of emergency, palliative care and oncology clinicians regarding the care of advanced cancer patients presenting to the ED.
Methods: Semi-structured focus groups were conducted with emergency, oncology and palliative care service providers until data saturation and supplemented with purposively sampled telephone interviews with emergency professionals from interstate and across a variety of health services.
Results: Eight focus groups were held with a total of 82 health professionals (45 ED, 8 oncology, 29 palliative care), and 11 telephone interviews were conducted. The main theme emerging from the data was of tensions and contradictions. The ED was “not the right place” with various environmental issues cited and concerns expressed about an approach to care that was inconsistent with the perceived needs of patients with advanced cancer; yet many ED staff spoke of the rewards of caring for this patient group and alluded to their particular skills in doing so. Tensions were identified within interdisciplinary relationships, particularly around the responsibility for decision-making and communication. The value of palliative care was acknowledged, yet was viewed as limited to end of life care, and exclusive of anti-cancer treatments. Concerns were expressed that labelling patients as ‘palliative’ may lead to inappropriate limiting of treatment options, yet simultaneously earlier involvement of palliative care services was considered desirable. ED presentations were viewed by participants as failures of the system and in some cases the legitimacy of presentations was questioned, yet there was consensus that there will always be a cohort of advanced cancer patients who appropriately present to the ED.
Conclusions: A richer understanding of perceptions, barriers and facilitators to care provides opportunities for the development of interventions to improve care for patients with advanced cancer at these times of crisis.