Caught in the middle: Tensions around the emergency department care of people with advanced cancer

Abstract

Background:People with advanced cancer frequently present to hospital EDs. International studies report conflicting attitudes towards providing such care and difficulties with communication. The experience of Australian clinicians, however, is not described.

Skills, expertise and role of Australian emergency clinicians in caring for people with advanced cancer

“…These quantitative data broadly support the qualitative findings of our earlier study of Australian clinicians in EM, oncology and palliative care 10. Emergency clinicians responding to our survey were clear in their views that the ED plays an important and appropriate role in providing urgent care for people with advanced cancer.…”

“…With respect to the skills and expertise of ED clinicians in managing these patients, our qualitative work has previously suggested some concern by ED clinicians in their ability to manage pain in this cohort of people 10. Less than a quarter of this national sample, in contrast, felt insufficiently skilled to manage such pain, particularly less experienced doctors, trainees and those who had not received palliative care education.…”

“…The survey was developed based on the findings emerging from previous qualitative work reported elsewhere 10. Using the emergent themes from these focus groups of emergency clinicians, oncologists and palliative care clinicians, members of the project team constructed items, followed by feedback between the whole project team in an iterative system to ensure face validity.…”

“…Specialist palliative care can be delivered alongside anticancer treatments such as chemotherapy or radiotherapy. While palliative medicine is a recognised subspecialty of EM in the USA,4 and its role in cancer care in US EDs is increasingly recognised,8 its importance and interaction with EM in Australasia is only now gaining significant attention 4 9 10…”

“…We recently reported qualitative data from the Australian hospital system showing that, despite limitations in the ED environment and resources, and EM clinicians’ concerns about time pressures, poorly defined pathways of care and the effects of ED overcrowding, oncology, palliative care and emergency clinicians broadly support the role the ED plays in providing care for people with advanced cancer 10. Emergency clinicians in this study reported tensions inherent in their role and expectations when managing patients with advanced cancer, namely a sense of conflict between their life-saving role and providing palliative and end-of-life care.…”