title: Management of patients on chemotherapeutic treatment for advanced cancer with acute conditions in the emergency department.
abstract: BACKGROUND
  Chemotherapy is increasingly used in people with advanced cancer to palliate symptoms and improve survival. New Zealand provides medical oncology services in a Hub and Spoke model, with an increasing emphasis on delivering treatment at out-patient spoke services, where after hours and urgent care is provided by the Emergency Department (ED). This study sought to describe the factors that influenced the care and clinical decision-making of this group of patients in the ED.
  
  
  METHODS
  Semi-structured telephone interviews were held with five ED nurses from three hospitals at the spoke. Raw data was thematically analysed via an exploratory descriptive approach.
  
  
  RESULTS
  Care of the oncology patient in ED is determined by the presentation itself, and differs little to the care delivered to other patient groups. That the patient is on chemotherapy may have little influence on the interventions provided. Challenges arise through patient complexity, lack of oncology specialist availability and low volumes preclude the maintenance of specialist skills and knowledge. Clinical decisions are influenced by local Hospice teams rather than Oncology team providing cancer treatment.
  
  
  CONCLUSIONS
  A more collaborative relationship between Oncology and ED nurses may support the provision of emergency care within the context of active cancer treatment.
authors.affiliation: Eastern Institute of Technology, Hawkes Bay Campus, 501 Gloucester Street, Taradale, Napier, New Zealand. Electronic address: LynneGray@tdh.org.nz.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Gray
authors.affiliation: Eastern Institute of Technology, Hawkes Bay Campus, 501 Gloucester Street, Taradale, Napier, New Zealand.
authors.forename: Salomé
authors.initials: S
authors.lastname: Meyer
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009520:New Zealand; D036301:Qualitative Research; D000078329:Workforce
keywords: Adult; Antineoplastic agent/ae [adverse effects]; Attitude of health personnel; Emergency nursing; Neoplasms; New Zealand