title: Ideals and compromises in palliative care.
abstract: This qualitative study explores the concept of ideal palliative care as it broadens its field of application from terminal care to include people earlier in the course of an illness. Focus groups were held with palliative care professionals from community, inpatient, and hospital consultancy services to examine this issue. Palliative care professionals have clear views of what constitutes ideal care that include: establishing a relationship, setting goals, communication, acceptance, advocacy, flexibility, symptom relief, and recognising the identity of each person. There was agreement upon the nature of obstacles that prevented ideal care being achieved including obstacles created by families, other health professionals, administrative structures, and conflicts between the aims of care for a particular patient. Finally each clinician has a well-developed set of personal views of the acceptable limits to practice, although these views vary widely. The clusters of ideas emerging in this study describe three objects of different ontologic status. The elements of ideal care are conceptual in nature, highlighting the aspirations for workers. The obstacles reflect the real world that palliative care professionals must negotiate each day, giving rise to a form of care that was good enough. The acceptable standards and their limits is the degree to which staff will or will not accept the compromises in care raised by the real world of practice, reflecting the ethical stance of the workers. The pursuit of ideal care may be motivated by a complex mix of aspirations, real-world practicalities and fulfilment for both patients and staff.
authors.affiliation: Palliative Care Service, Alfred Hospital, Prahran, Victoria, Australia. jennifer.philip@alfred.org.au
authors.forename: Jennifer A M
authors.initials: JA
authors.lastname: Philip
authors.forename: Paul
authors.initials: P
authors.lastname: Komesaroff
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards*; D014739:Victoria