title: Refractory suffering: the impact of team dynamics on the interdisciplinary palliative care team.
abstract: OBJECTIVE
  This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.
  
  
  METHODS
  Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.
  
  
  RESULTS
  In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.
  
  
  CONCLUSIONS
  The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.
authors.affiliation: Southern Adelaide Palliative Services, 700 Goodwood Park, Daw Park, SA 5041, Australia. kate.swetenham@health.sa.gov.au
authors.forename: Kate
authors.initials: K
authors.lastname: Swetenham
authors.forename: Meg
authors.initials: M
authors.lastname: Hegarty
authors.forename: Katrina
authors.initials: K
authors.lastname: Breaden
authors.forename: Carol
authors.initials: C
authors.lastname: Grbich
mesh_terms: D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010148:Intractable Pain / Q000209:etiology* / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D010348:Patient Care Team / Q000458:organization & administration*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D000078329:Workforce