Supporting Patients With Incurable Cancer: Backup Behavior in Multidisciplinary Cross-Functional Teams

Abstract

Caring for patients with incurable cancer presents unique challenges. Managing symptoms that evolve with changing clinical status and, at the same time, ensuring alignment with patient goals demands specific attention from clinicians. With care needs that often transcend traditional service provision boundaries, patients who seek palliation commonly interface with a team of providers that represents multiple disciplines across multiple settings. In this case study, we explore some of the dynamics of a cross-disciplinary approach to symptom management in an integrated outpatient radiotherapy service model. Providers who care for patients with incurable cancer must rely on one another to secure delivery of the right services at the right time by the right person. In a model of shared responsibilities, flexibility in who does what and when can enhance overall team performance. Adapting requires within-team and between-team monitoring of task and function execution for any given patient. This can be facilitated by a common understanding of the purpose of the clinical team and an awareness of the particular circumstances surrounding care provision. Backup behavior, in which one team member steps in to help another meet an expectation that would otherwise not be fulfilled, is a supportive team practice that may follow naturally in high-functioning teams. Such team processes as these have a place in the care of patients with incurable cancer and help to ensure that individual provider efforts more effectively translate into improved palliation for patients with unmet needs.

Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings

“…The repeated discussions (and reasons mentioned above in Results section) point to the complexities involved with the outpatient cancer rehabilitation population. The problems were identified over time with multiple therapy sessions and reported to physiatrists at consecutively scheduled monthly team meetings for further recommendations. This again points to the complexities involved with the outpatient cancer rehabilitation population (with and without active disease status), whose multitude of problems sometimes required multiple (up to 4) recommendations (see Table ) and also sometimes required (1‐3) repeated monthly discussions to address new, worsened or refractory problems.…”

Characteristics and Symptom Profiles of Patients Evaluated By A Nurse Practitioner Consultant In A Multidisciplinary Palliative Radiotherapy Clinic.

“…Adequately assessing the domains of care (physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, ethical and legal issues [11,12]) requires the RO has su cient time as well as function well within an effective MDT [5]. Shared knowledge where one member can step in, or 'backup behavior' is characteristic of high-functioning and e cient teams [13]. Shared responsibility and professional trust allows the right MDT provider(s) to deliver the right care at the right time to the right patient(s), characteristic of 'personalized care' and essential to address the complex symptoms of a palliative RT population.…”

Evolution of the Radiation Therapist Role in a Multidisciplinary Palliative Radiation Oncology Clinic

“…Working with an RN in a shared role has created a natural opportunity to cross-train with a unique combination of educational and experiential backgrounds. These interprofessional skills interface for optimum execution of key team processes, such as mutual performance monitoring and back-up behavior [24].…”

“…Research and collaboration with other professionals on a multitude of connected projects keeps the role interesting and engaging, connecting MDT members on shared academic projects in addition to fostering clinical partnerships. Examples of MDT research involvement include academic studies initiated by PRTs [16,26], case reports [27], involvement in MDT survival prediction [28], and an international initiative aimed at understanding MDT behavior [24].…”