title: Ideal care and the realities of practice: interdisciplinary relationships in the management of advanced cancer patients in Australian emergency departments.
abstract: OBJECTIVE
  Over the course of their illness, a person with cancer is likely to see a number of different healthcare professionals, including those in the emergency department (ED). There is limited research examining the interaction and communication between the involved healthcare professionals when such a patient presents to the ED. This study aimed to explore the views and experiences of interdisciplinary interactions of healthcare professionals caring for patients with advanced cancer who present to the ED.
  
  
  METHODS
  Focus groups and semistructured interviews were conducted with clinical staff working in ED, oncology and community and hospital-based palliative care services. Interviews and focus groups were recorded and transcribed verbatim. Thematic analysis was undertaken by three researchers independently. These themes were then discussed by the wider team and consensus reached on themes and subthemes.
  
  
  RESULTS
  Eighty-three healthcare professionals participated in focus groups, and 11 were interviewed. The over-arching theme to emerge was one of a conflict between ideal care and the realities of practice, particularly arising where clinicians from different services were required to work together to provide care. This idea was further understood through a series of subthemes including communication, decision-making and understanding of other services.
  
  
  CONCLUSIONS
  Participants articulated agreed upon ideals of optimal care for advanced cancer patients across all three services, however there was frequently discord between these ideals and the actual care provided. Service demands and the day-to-day stressors of practice appeared to influence people's actions and engender conflict.
authors.affiliation: Centre for Palliative Care, St Vincent's Hospital and the University of Melbourne, P.O. Box 2900, Fitzroy, Victoria, 3065, Australia, heather.lane@svhm.org.au.
authors.forename: H
authors.initials: H
authors.lastname: Lane
authors.forename: J
authors.initials: J
authors.lastname: Weil
authors.forename: G A
authors.initials: GA
authors.lastname: Jelinek
authors.forename: M
authors.initials: M
authors.lastname: Boughey
authors.forename: C H
authors.initials: CH
authors.lastname: Marck
authors.forename: T J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: A
authors.initials: A
authors.lastname: Haydon
authors.forename: J
authors.initials: J
authors.lastname: Philip
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D004636:Emergency Service, Hospital; D017144:Focus Groups; D006282:Health Personnel; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D011369:Professional-Patient Relations