title: Complexity in caring for patients with advanced cancer.
abstract: BACKGROUND
  The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi-centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge-exchange programme between nurse researchers, practitioners and students.
  
  
  OBJECTIVE
  The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors.
  
  
  RESULTS
  The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions.
  
  
  CONCLUSIONS
  These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.
authors.affiliation: Department of Nursing, Karolinska Institute, Stockholm, Sweden. carol.tishelman@omv.ki.se
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Bernhardson
authors.forename: Karin
authors.initials: K
authors.lastname: Blomberg
authors.forename: Sussanne
authors.initials: S
authors.lastname: Börjeson
authors.forename: Liselotte
authors.initials: L
authors.lastname: Franklin
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.forename: Helena
authors.initials: H
authors.lastname: Leveälahti
authors.forename: Eva
authors.initials: E
authors.lastname: Sahlberg-Blom
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ternestedt
mesh_terms: D017144:Focus Groups; D006801:Humans; D009369:Neoplasms / Q000451:nursing*; D015404:Nursing Methodology Research; D009736:Nursing Process / Q000592:standards; D009859:Oncology Nursing / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013548:Sweden