Interprofessional case conferences to bridge perception gaps regarding ethical dilemmas in home-based end-of-life care: a qualitative study

Abstract

Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions. Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach. Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues. Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.

Improving person-centered advance care planning conversation with older people: a qualitative study of core components perceived by healthcare professionals

“…In-depth interview skills are essential for doctors, especially psychiatrists and palliative care clinicians 34,35) . Social workers receive intensive training in in-depth interviewing techniques as part of their education, and recognize person-centered interviewing with their clients as their responsibility within the interdisciplinary care team [36][37][38] . However, physicians tend to prefer dealing with informed consent, which is at the heart of decision making, and are generally ill-prepared to discuss broader aspects such as patients' personal values and preferences 39) .…”

“…Previous literature suggested that the learning and practical experience of interprofessional teams working on common goals to improve patient outcomes increased understanding, shared values, and respect for the roles of other healthcare professionals 46,47) . For example, interprofessional case conferences with end-of-life case scenarios involving sensitive moral and ethical issues improved healthcare professionals' communication and conflict resolution skills 38) and ethically difficult cases that need to be resolved quickly, there are usually multiple factors to consider including patients' values and preferences, and relatives' concerns and values. In these situations, interprofessional case conference participants could resort to a widely used systematic approach such as the four topics approach to clinical ethical case analysis described by Jonsen et al 48) to collect necessary data and ensure the success of the conflict resolution strategy.…”

“…Previous literature suggested that the learning and practical experience of interprofessional teams working on common goals to improve patient outcomes increased understanding, shared values, and respect for the roles of other healthcare professionals 46 , 47 ) . For example, interprofessional case conferences with end-of-life case scenarios involving sensitive moral and ethical issues improved healthcare professionals’ communication and conflict resolution skills 38 ) . In clinically and ethically difficult cases that need to be resolved quickly, there are usually multiple factors to consider including patients’ values and preferences, and relatives’ concerns and values.…”

Dilemas éticos na tomada de decisões no fim da vida: sob a ótica do cuidado humanizado

“…Prevenção (previsão de possíveis complicações e/ou sintomas afim de evitar sofrimentos desnecessários); 5. Não abandono (a permanência junto ao paciente, garantindo a comunicação empática para auxiliá-lo em suas decisões) (12,13).…”

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians

“…While ACP provides healthcare professionals with valuable tools to meet patients' needs in a person-centered manner, several potential ethical challenges are inherent in the process [4,5]. Ethical dilemmas and conflicts (i.e., withholding aggressive management, withdrawing life-sustaining treatment, ascertaining patient autonomy) can arise in endof-life care when a difficult problem cannot be solved in a way that will satisfy everyone involved [5]. Thus, ethical reasoning is a significant component of ACP that affects the actions of patients, their families, and healthcare professionals.…”