An exploratory study of interprofessional collaboration in end-of-life decision-making beyond palliative care settings

Abstract

As healthcare delivery becomes increasingly interprofessional, it is imperative to identify opportunities for effective collaboration and coordination of care. Drawing on a Canadian qualitative study that adopted a constant comparative method based on the grounded theory approach, we report how healthcare providers' (HCPs) personal experiences and professional roles intersect with system factors in hindering or enhancing their ability to support patients and families in planning for end-of-life (EOL) care. We used a criterion-based sampling strategy and sought HCPs who had direct experience engaging patients and families in complex healthcare decisions on: (1) initiating, withholding, or withdrawing treatment; (2) care planning; and/or (3) discharge planning. Interviews sought to understand what HCPs perceived as individual, (inter)professional, and system factors that might hinder, promote, or enhance support for patients/families. We present four major intersecting themes from in-depth interviews with 28 HCPs across acute, long-term, and community care settings that represent three barriers and one facilitator: discomfort with death and dying, confusion about role responsibility, lack of coordinated care, and importance of interprofessional teamwork. Attending to system power hierarchy, we explore interprofessional strategies to support patients' and families' care experiences and promote team-based decision-making. We recommend an interprofessional team approach to facilitate EOL decision-making across care settings and before death becomes imminent. Increasing educational initiatives and developing tools that focus on interprofessional collaboration may help HCPs to understand each other's roles and perspectives, so that they can work together to provide a more coherent and coordinated approach to EOL decision-making.

Impact of advance care planning on end-of-life management

“…They also noted confusion of role responsibilities in end-of-life communication and lack of coordinated care among settings. The interprofessional teamwork was found as the key facilitator (36). Patients often report discomfort with ACP conversation, although they found such conversations necessary and valuable (11).…”

Labouring Together: collaborative alliances in maternity care in Victoria, Australia—protocol of a mixed-methods study

“…Debate continues on how best to incorporate shared decision-making with women as the consumers of healthcare into the interprofessional collaborative decision-making alliance. 50 [53][54][55][56][57][58][59][60][61][62][63] In maternity care, clinicians' lack of understanding of women's autonomy with decision-making and the law has been identified as a particular barrier to shared decision-making. 64 Women, as the consumers of maternity care, may also experience barriers that affect their engagement with decision-making as part of the collaborative alliance.…”

Making good death more accessible: end-of-life care in the intensive care unit

“…Some physicians' recognition of the importance of offering palliative services in the acute and critical care arenas takes the form of deferring end-of-life conversations to palliative care teams rather than developing one's own skills in holding these discussions [14], suggesting the need to incorporate end-of-life and ethics education in not only medical school or residency training but also in postgraduate continuing education [15]. In considering effective and efficient allocation of healthcare resources as well as physical and psychological harm that can be incurred in prolonging the dying process, there is a critical need to reframe end-of-life care planning in the ICU.…”

“…Nonetheless, even Confucian ethics, which values family relationships and is often adopted by many rooted in Chinese culture, does not prioritize life extension over good death [16]. Helping clinicians and families to understand how end-of-life planning is an active rather than a passive form of care to facilitate the best outcome-a well-coordinated and interprofessional care experience that corresponds with the patient's and family's values and priorities given the clinical realitiesis thus important [14]. Communication and intervention withdrawal practice guidelines that highlight end-of-life care as part of rather than separate from critical care and education regarding how to implement such practice [17] may be crucial in supporting ICU teams to help make good death more accessible.…”