The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States

Duberstein, Paul R.; Hoerger, Michael; Norton, Sally A.; Mohile, Supriya G.; Dahlberg, Britt; Hyatt, Erica Goldblatt; Epstein, Ronald M.; Wittink, Marsha N.

doi:10.1016/j.socscimed.2022.115546

Cited by 7 publications

(4 citation statements)

References 197 publications

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“…Based on these findings and our clinical experience in cancer care and communication skills training, we propose an ACP communication model (Fig. 1), developed with the consideration of factors reported to influence ACP uptake [13 ▪▪ ] and communication in healthcare [14], and integrating socioemotional processes [53 ▪▪ ].…”

Section: Discussionmentioning

confidence: 99%

Advance care planning in oncology: a scoping review and some recommendations

Libert,

Choucroun,

Razavi

et al. 2023

Current Opinion in Oncology

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Purpose of reviewCancer patients' communication with their relatives and healthcare professionals (HCPs) is essential for advance care planning (ACP). The purpose of this scoping review was to synthesize recent research findings about factors enabling cancer patients', their relatives', and physicians' communication about ACP, and to propose recommendations for future ACP implementation in cancer care. Recent findingsThis review confirmed the importance of aspects of the cancer care context (i.e., culture) as ACP uptakepredisposing and -enabling factors. It highlighted the difficulty of determining who should initiate ACP discussion, with which patients and at what time-points. It also highlighted a lack of consideration for socioemotional processes in the study of ACP uptake despite evidence that cancer patients', relatives' and physicians' discomforts that arise from communication about end-of-life and the wish to safeguard each other are main obstacles to ACP implementation.

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Section: Discussionmentioning

confidence: 99%

Advance care planning in oncology: a scoping review and some recommendations

Libert,

Choucroun,

Razavi

et al. 2023

Current Opinion in Oncology

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“…Deimplementation in healthcare, of which deprescribing is an example, can provoke emotions and psychological biases in clinicians that hinder action [ 39 , 40 ]. The psychological context and requirements of deimplementation differ substantially: deimplementation involves “unlearning,” which can induce emotional reactance that increases,rather than decreases, the commitment to the prior learning [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, pharmacists utilized neutral language and expression, endorsed self-confidence and expertise, acknowledged the need for emotionally aware communication around deprescribing, and recognized how patient context could affect their ability to understand medications. Deimplementation in healthcare, of which deprescribing is an example, can provoke emotions and psychological biases in clinicians that hinder action [39,40]. The psychological context and requirements of deimplementation differ substantially: deimplementation involves "unlearning," which can induce emotional reactance that increases,rather than decreases, the commitment to the prior learning [41].…”

Section: Discussionmentioning

confidence: 99%

Emotional barriers and facilitators of deprescribing for older adults with cancer and polypharmacy: a qualitative study

Ramsdale,

Malhotra,

Holmes

et al. 2023

Support Care Cancer

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Purpose To describe emotional barriers and facilitators to deprescribing (the planned reduction or discontinuation of medications) in older adults with cancer and polypharmacy. Methods Virtual focus groups were conducted over Zoom with 5 key informant groups: oncologists, oncology nurses, primary care physicians, pharmacists, and patients. All groups were video- and audio-recorded and transcribed verbatim. Focus group transcripts were analyzed using inductive content analysis, and open coding was performed by two coders. A codebook was generated based on the initial round of open coding and updated throughout the analytic process. Codes and themes were discussed for each transcript until consensus was reached. Emotion coding (identifying text segments expressing emotion, naming the emotion, and assigning a label of positive or negative) was performed by both coders to validate the open coding findings. Results All groups agreed that polypharmacy is a significant problem. For clinicians, emotional barriers to deprescribing include fear of moral judgment from patients and colleagues, frustration toward patients, and feelings of incompetence. Oncologists and patients expressed ambivalence about deprescribing due to role expectations that physicians “heal with med[ication]s.” Emotional facilitators of deprescribing included the involvement of pharmacists, who were perceived to be neutral, discerning experts. Pharmacists described emotionally aware communication strategies when discussing deprescribing with other clinicians and expressed increased awareness of patient context. Conclusion Deprescribing can elicit strong and predominantly negative emotions among clinicians and patients which could inhibit deprescribing interventions. The involvement of pharmacists in deprescribing interventions could mitigate these emotional barriers. Trial registration ClinicalTrials.gov Identifier: NCT05046171. Date of registration: September 16, 2021.

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“…Efforts to improve goal-aligned care have primarily focused on improving the communication of individual clinicians with patients and their surrogate decision-makers ( 6 – 8 ). However, ICU care involves large interprofessional teams, and collaboration within these teams influences the quality of care ( 9 – 12 ). Despite growing attention to interprofessional collaboration, little is known about how and to what extent different professions on an ICU team work together to deliver goal-aligned care.…”

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confidence: 99%

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

et al. 2023

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Rationale Although aligning care with patient goals is fundamental to critical care, this process is often delayed and leads to conflict among patients, families, and intensive care unit (ICU) teams. Interprofessional collaboration within ICU teams is an opportunity to improve goal-aligned care, yet this collaboration is poorly understood. A better understanding of how ICU team members work together to provide goal-aligned care may identify new strategies for improvement. Objectives Transactive memory systems is a theory of group mind that explains how high-performing teams use a shared memory and collective cognition. We applied this theory to characterize the process of interprofessional collaboration within ICU teams and its relationship with goal-aligned care. Methods We conducted a secondary analysis of focus group ( n = 10) and semistructured interview ( n = 8) transcripts, gathered during a parent study at two academic medical centers on the process of ICU care delivery in acute respiratory failure. Participants ( N = 70) included interprofessional ICU and palliative care team members, surrogates, and patient survivors. We used directed content analysis, applying transactive memory systems theory and its major components (specialization, coordination, credibility) to examine ICU team collaboration. Results Participants described each ICU profession as having a specialized role in aligning care with patient goals. Different professions have different opportunities to gather knowledge about patient goals and priorities, which results in dispersion of this knowledge among different team members. To share and use this dispersed knowledge, ICU teams rely on an informal coordination process and “side conversations.” This process is a workaround for formal channels (e.g., health records, interprofessional rounds) that do not adequately convey knowledge about patient goals. This informal process does not occur if team members are discouraged from asserting their knowledge because of hierarchy or lack of psychological safety. Conversely, coordination succeeds when team members recognize each other as credible sources of valued knowledge. Conclusions We found that ICU team members work together to align care with patient goals and priorities, using transactive memory systems. The successful function of these systems can be disrupted or promoted by ICU organizational and cultural factors, which are potential targets for efforts to increase goal-aligned care.

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The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States

Cited by 7 publications

References 197 publications

Advance care planning in oncology: a scoping review and some recommendations

Advance care planning in oncology: a scoping review and some recommendations

Emotional barriers and facilitators of deprescribing for older adults with cancer and polypharmacy: a qualitative study

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

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