title: "Better pathways of care": suggested improvements to the emergency department management of people with advanced cancer.
abstract: OBJECTIVE
  It is difficult to provide optimal care to people with advanced cancer presenting to emergency departments (EDs). Recent data suggest that the ED environment, the skills and priorities of treating staff, and the lack of clear communication related to goals of care contribute to the difficulty. By exploring the views of emergency, palliative care (PC), and oncology clinicians on the care of these patients, this study aimed to describe potential solutions.
  
  
  METHODS
  This qualitative study involved focus groups with clinicians at two major hospitals and two community PC services in Melbourne, Australia, and semistructured telephone interviews with emergency clinicians from all other Australian states and territories. Discussions were recorded and transcribed verbatim. Thematic analysis identified ways to improve or enhance care.
  
  
  RESULTS
  Throughout discussions with 94 clinicians, a number of possible improvements to care were raised; these were broadly grouped into service areas: clinical care, pathways, information access, and education.
  
  
  CONCLUSIONS
  The provision of care to patients with advanced cancer in the ED occurs across sites, across disciplines, and across teams. To make improvements to care, we must address these complexities. The improvements suggested in this study place the patient (and the patient's family) at the centre of care.
authors: George A
authors: GA
authors: Jelinek
authors: Mark
authors: M
authors: Boughey
authors: Claudia H
authors: CH
authors: Marck
authors: Jennifer
authors: J
authors: Phillip
authors: Jennifer
authors: J
authors: Weil
authors: Heather
authors: H
authors: Lane
authors: Tracey J
authors: TJ
authors: Weiland
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence; D019091:Critical Pathways / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017144:Focus Groups; D006764:Hospitals, Community / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration; D018802:Patient-Centered Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D058996:Quality Improvement / Q000458:organization & administration*