Interdisciplinary Approaches to Assisting with End-of-life Care and Decision Making

Abstract

The importance of interdisciplinary care for patients and families facing the end of life is examined. Descriptions of varying forms of team functioning are provided with an emphasis on the characteristics of high-functioning interdisciplinary teams. The value of empowering the patient and family to direct the care they receive from their team is emphasized. Interdisciplinary team interventions in end-of-life care focus on the biopsychosocial and spiritual dimensions of human experience and facilitate growth and development in the last phase of life. Despite its great promise for improving patient care, the interdisciplinary model is notwith the exception of hospice care-widely implemented in today's health care system. The contributions of interdisciplinary teams to end-of-life care can be enhanced through the development of interdisciplinary team training programs, the creation of payment structures that support the interdisciplinary team model, and continuing research assessing the dynamics of team functioning and the benefits that interdisciplinary team care provides to patients and families near the end of life.Interdisciplinary team care is in general not well represented in either the health care system or in the published literature that studies this system. However, interdisciplinary team care is a key ingredient in health care for patients with chronic or life-threatening illness because these patients present a range of problems that affect all dimensions of human experience and that require the expertise of many professional disciplines. How these disciplines work together 340

End-of-life Care and Interprofessional Communication: Not Simply a Matter of "More"

“…While the everyday conversations of teams seemed to have embedded within them the assumption of a team as an integrated machine (as a Fordist model, a group with a common vision, implicitly without conflict), given specialized professionalization it would seem that this understanding is insufficient. Teams need to be constituted with a clear understanding of the strong historical, emotive, philosophical, and socio-cultural roots that underpin the divisions between the professions (Puntillo and McAdams, 2006) and the tendency for cross-disciplinary misunderstanding and defensiveness between disciplines to arise (Connor, et al, 2002;Rafferty, 1996;Reese and Sontag, 2001;Wicks, 1998). While teams typically come together because they share a common goal or purpose, a team can become even "tighter" if there is a perceived common adversary who interferes with their ability to achieve their goal.…”

“…Fundamentally an interprofessional practice, a palliative approach is dependent on coordinated care between interprofessional team members (Connor, Egan, Kwilosz, Larson, & Reese, 2002;Ellingson, 2003;Reese & Sontag, 2001;Wittenberg-Lyles, Parker Oliver, Demiris, & Regehr, 2007;Wittenberg-Lyles, Parker Oliver, Demiris, & Regehr, 2009). Specifically, interprofessional collaboration has been shown to improve patient outcomes, such as symptom control and self-determination at end-oflife (Hearn & Higginson, 1998), as well as nurses' and physicians' job satisfaction (Manojlovich, 2005).…”

The Interdisciplinary Team

“…The lack of interdisciplinary education leads to diminished understanding of the roles of other team members and can result in isolation. 8 One study of the outcomes of a day-long interdisciplinary palliative care course yielded high satisfaction rates. However, fewer medical students were involved when compared with other disciplines.…”

“…1 Group interaction skills, communication techniques, and conflict resolution are all topics that teams must address. 8 Interestingly, much understanding of team training comes from other industries, particularly aviation. For example, a program called Crew Resource Management (CRM) was developed to ensure aircraft safety by fostering appropriate team attitudes among pilots and cockpit crews.…”

Transitions Model: Melding of Psychotherapy and Palliative Care Using Teams

“…Often the physical reality of death is at issue, but the social reality of dying seems always an issue. From the patient and family perspective, Connor, Egan, Kwilosz, Larson, and Reese (2002) argued that dying is a unique experience belonging to the patient and family; that patients and families experience the last phase of life through many dimensions; and that the last phase of life presents many opportunities for positive growth and development. From the staff's perspective, Bern-Klug (2009) identified five categories of a stance toward dying; dying allowed, dying contested, mixed message dying, not dying, and not enough information.…”