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Exploring health care professionals’ perceptions regarding shared clinical decision-making in both acute and palliative cancer care
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, Stockholm, Sweden.ORCID-id: 0000-0001-5747-853x
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Center, Stockholm, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.ORCID-id: 0000-0002-1248-5581
Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
2022 (Engelska)Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 23, artikel-id 16134Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home. Methods: Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Results: Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Conclusions: Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).

Ort, förlag, år, upplaga, sidor
MDPI, 2022. Vol. 19, nr 23, artikel-id 16134
Nyckelord [en]
cancer care, clinical decision-making, clinical research home care, focus groups, palliative care
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Omvårdnad
Identifikatorer
URN: urn:nbn:se:umu:diva-203331DOI: 10.3390/ijerph192316134ISI: 000896061800001PubMedID: 36498204Scopus ID: 2-s2.0-85143725411OAI: oai:DiVA.org:umu-203331DiVA, id: diva2:1728224
Forskningsfinansiär
Cancerforskningsfonden i Norrland, AMP 18-928Tillgänglig från: 2023-01-18 Skapad: 2023-01-18 Senast uppdaterad: 2023-01-18Bibliografiskt granskad

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Ullgren, HelenaSharp, LenaFransson, Per

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