Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project

Abstract

Much improvement is needed to facilitate patient involvement in medical decision-making related to life-prolonging care. Prior research focuses mainly on the communication in the physician-patient dyad; few studies have identified how other professionals are involved. Using a Research Action design, two rounds of interviews with four interprofessional groups from various clinical settings of a health center in Quebec, Canada were conducted between 2009 and 2010. The 37 participants represented nine professions (nurse, dietitian, occupational therapist, orderly, pastoral worker, physician, physiotherapist, respiratory therapist and social worker). The first round of interviews confirmed that all of these professionals are involved, in various ways, in communicating with patients regarding their goals of care. Based on these results, the research group developed two communications tools (paper forms) to facilitate the documentation of patient care goals. The first form includes a designated area where all professionals can note patients' comments regarding decisions related to life-prolonging care. The second is a prescription form to document in the medical file the patient's goals of care. Both tools were submitted to, and fine-tuned by, the professionals in the second round of interviews. These results confirm that interprofessional collaboration to facilitate patient participation in goals-of-care decisions is both possible and valued.

The advocacy role of nurses in cardiopulmonary resuscitation

“…As in the study developed by Sohi et al, 53 participant nurses believed the role they play was underestimated compared with the role of the physician. Nurses’ invisibility in making decisions is a cause for moral distress, when on occasions they feel that CPR is initiated on patients when not indicated 54 because it is difficult for nurses to be at the patient’s side and not a part of the decision-making.…”

Connecting patient experience, leadership, and the importance of involvement, information, and empathy in the care process

“…4,8 This includes ongoing discussion and mutual understanding between the patient and the physician, information flow between all members of the care team, and use of documentation systems and processes. 4,11 During the 19 days Adrienne spent in the hospital, both she and Michael received conflicting information from members of the care team, including infection prevention procedures and visitor guidelines. One nurse told Michael to wear a gown, cap, and gloves during his visit, another said it was not necessary.…”

“…Taking the time to listen and to empathize is also foundational to patient participation and engagement in care. 11 Adrienne believes that a healthcare worker's greatest tool is listening. Patients often perceive that care team members are busy and may not have time to talk or answer questions 12 ; it is also often presumed by care team members that shared decision-making is time-consuming.…”

“…4,8 This includes ongoing discussion and mutual understanding between the patient and the physician, information flow between all members of the care team, and use of documentation systems and processes. 4,11…”

Patient involvement in surgical care–Healthcare personnel views and behaviour regarding patient involvement

“…Teamwork is hampered by the care staff talking in a language the patient does not understand (medical terms) or talking over the patient's head (17). Professionals who collaborate effectively with other members of other professions stimulate and facilitate teamwork (18).…”