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- Title
Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study.
- Authors
Lakin, Joshua R.; Benotti, Emily; Paladino, Joanna; Henrich, Natalie; Sanders, Justin
- Abstract
Background: Evidence demonstrates that discussion between clinicians and seriously ill patients about their goals and preferences, or serious illness communication, is a high-value intervention, resulting in growing demand for improvement in this area. Promising efforts address this demand utilizing interprofessional teams; yet, we lack insight into how different professions work together to deliver better serious illness communication. Objective: To explore the perceptions of primary care clinicians about interprofessional work in serious illness communication. Design: Qualitative analysis of semistructured key informant interviews. Settings/Subjects: Primary care clinicians (physicians, care coordination nurses, and social workers) who have experience implementing a structured primary palliative care program, the Serious Illness Care Program, at a large academic medical center in Boston, Massachusetts. Results: We derived primary themes and subthemes from participant descriptions of program implementation: the importance and value of interprofessional teams, nurses, and individual initiative; the role of preparation and structure in enabling high-quality communication; and the ways in which attempts to improve serious illness communication reveal other problems that can limit program effectiveness or be perceived as program failures. We derived a conceptual model that illustrates the relationships between interprofessional team interactions, workflows, and perceived program outcomes. Conclusions: This study suggests three key areas of focus for design and implementation of programs aimed at improving serious illness conversations by interprofessional primary care teams: establishing clear professional roles and responsibilities, paying special attention to interprofessional and clinician-patient relationships, and clearly structuring interventions aiming to change the way our system drives serious illness communication.
- Subjects
MASSACHUSETTS; ACADEMIC medical centers; COMMUNICATION; HEALTH care teams; INTEGRATED health care delivery; INTERPROFESSIONAL relations; INTERVIEWING; RESEARCH methodology; NURSES' attitudes; PALLIATIVE treatment; PHYSICIAN-patient relations; GENERAL practitioners; PRIMARY health care; TEAMS in the workplace; WORKFLOW; QUALITATIVE research; PSYCHOSOCIAL factors; HUMAN services programs; EVALUATION of human services programs; SOCIAL worker attitudes; ATTITUDES toward illness
- Publication
Journal of Palliative Medicine, 2019, Vol 22, Issue 7, p751
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2018.0471