title: Challenging situations when administering palliative chemotherapy - a nursing perspective.
abstract: Palliative chemotherapy treatments (PCT) are becoming more common for patients with incurable cancer; a basic challenge is to optimize tumour response while minimizing side-effects and harm. As registered nurses most often administer PCT, they are most likely to be confronted with difficult situations during PCT administration. This study explores challenging situations experienced by nurses when administering PCT to patients with incurable cancer.
  
  
  METHODS
  Registered nurses experienced in administering PCT were asked in interviews to recall PCT situations they found challenging. Inspired by the narrative tradition, stories were elicited and analysed using a structural and thematic narrative analysis.
  
  
  RESULTS
  A total of twenty-eight stories were narrated by seventeen nurses. Twenty of these were dilemmas that could be sorted into three storylines containing one to three dilemmatic situations each. The six dilemmatic situations broadly related to three interwoven areas: the uncertainty of the outcome when giving potent drugs to vulnerable patients; the difficulty of resisting giving PCT to patients who want it; and insufficient communication between nurses and physician.
  
  
  CONCLUSIONS
  Nurses who administer PCT are engaged in a complex task that can give rise to a number of dilemmatic situations. The findings may be interpreted as meaning that at least some situations might be preventable if the knowledge and insight of all team members - nurses, physicians, patients, and relatives - are jointly communicated and taken into account when deciding whether or not to give PCT. Forming palliative care teams early in the PCT trajectory, could be beneficial for staff and patients.
authors.affiliation: Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden; Department of Nursing, Umeå University, S-901 87 Umeå, Sweden. Electronic address: ulla.nappa@jll.se.
authors.forename: Ulla
authors.initials: U
authors.lastname: Näppä
authors.affiliation: Department of Nursing, Umeå University, S-901 87 Umeå, Sweden. Electronic address: birgit.rasmussen@umu.se.
authors.forename: Birgit H
authors.initials: BH
authors.lastname: Rasmussen
authors.affiliation: Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden. Electronic address: Bertil.axelsson@jll.se.
authors.forename: Bertil
authors.initials: B
authors.lastname: Axelsson
authors.affiliation: Department of Nursing, Umeå University, S-901 87 Umeå, Sweden; Department of Learning, Informatics, Management and Ethics/Medical Management Centre, Karolinska Institutet, S-171 77 Stockholm, Sweden. Electronic address: olav.lindqvist@ki.se.
authors.forename: Olav
authors.initials: O
authors.lastname: Lindqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003142:Communication; D003657:Decision Making; D004358:Drug Therapy / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing* / Q000523:psychology; D009741:Nursing Staff, Hospital / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D010820:Physicians / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Communication barriers; Dilemma; Narrative; Palliative chemotherapy; Patient care team; Registered nurse