Exploring stakeholder experiences of interprofessional teamwork in sex development outpatient clinics

Abstract

Adopting an interprofessional team approach to care of the child with rare conditions that can affect sex development (DSD) has been advocated by a consensus document within the last decade. In the United Kingdom, the approach appears orientated towards an interprofessional model with the integration of separate professions working in single consultations with families working collaboratively to focus on care using a person and family-centred lens. This concurrent mixed-methods UK study using questionnaires, observation, and interviews aimed to examine professionals', patients', and parents' expectations and interactions during DSD clinic. In adapting a model of patient and family-centred care, we were able to analyse the dimensions of care at the micro-, meso-, and macro-level. The micro captured the unique nature of the bio-psychosocial aspects of DSD, professional capabilities, and communication. The meso examined shared learning and objective setting as well as aspects of knowledge translation. The macro focused on the operational aspects and the emancipatory knowing embedded within DSD care. Complete data from participants (n = 105) were analysed from 47 outpatient clinical consultations and are reported as numerical data, tables, and participants' voices. Interestingly, all participants identified topics or concerns that were absent in the dialogues during consultation. Our findings informed the adaptation of a patient-focused model, thereby supporting the development of the concept of patient-centeredness, integration, and collaboration. This framework may serve as a platform, embedding existing evaluative tools and acknowledging the patient and professional partnership necessary in DSD care. ARTICLE HISTORY

Multidisciplinary teams caring for people with variations of sex characteristics: a scoping review

“…Out of the final 12 articles, 6 were theoretical, [11][12][13][14][15][16] 5 were empirical [17][18][19][20][21] and 1 was a mixed-method study. 9 Onethird (4) of the articles were published in the UK, 9 11 12 18 the other third in the USA 13 15 17 20 and the remaining third came from Switzerland and Germany, 21 Sweden and UK, 19 Australia 16 and Germany 14 (see tables 2 and 3).…”

“…Still most of the papers seemed to indicate a multidisciplinary approach in MDTs described as the simultaneous but independent contribution of two or more team members. Two empirical studies 19 21 and the mixed-methods study 9 show that although participants referred to their team as an MDT or even interprofessional, their responses reflect a disintegrated approach.…”

“…In most empirical [17][18][19][20][21] and theoretical [11][12][13][14][15][16] articles the model of collaboration was not explicitly mentioned but most of the papers seem to indicate that MDTs take a multidisciplinary approach insofar the teamwork was described as the simultaneous and independent contribution of two or more team members. Only the mixedmethods study of Sanders and colleagues 9 included an interprofessional team approach where patients, parents and members of the MDT actively cooperate in the treatment process in order to cocreate knowledge and improve the care of people with VSC and help parents cope with their child's condition.…”

Parents' expectations of the outpatient care for daytime urinary incontinence in children: A qualitative study

“…We developed an interview guide based on research questions, clinical experiences, and literature review (Appendix A) [10][11][12][13]. The guide was used to initiate the interview and stimulate discussion.…”

Methodological Issues for Psychological Evaluation across the Lifespan of Individuals with a Difference/Disorder of Sex Development

“…However, further methodological considerations pertain to the approach and goal(s) of individual evaluations, including attention to a patient's particular needs and the patienthealthcare professional relationship. For example, a study looking at stakeholder experiences of interprofessional teamwork in DSD revealed that consistency among team members and review with professionals known to the family was described as very helpful in coping with clinical aspects of DSD [Sanders et al, 2017].…”