Reconsidering the team concept: Educational implications for patient-centered cancer care

Abstract

Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated 'team' concept, and suggest the concept of a 'care community' as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.

Shared Mind: Communication, Decision Making, and Autonomy in Serious Illness

“…51,52 In health care, attunement has been described within patient-clinician dyads, 42,49,53,54 family and social systems, 55 health care teams, 56 teacher-learner relationships, 57,58 organizations, 59 and communities of care. 60,61 Cognitive neuroscientists, 18,62,63 using functional neuroimaging studies, are now proposing a neural basis of attunement, building upon prior observations by philosophers [64][65][66][67] and psychotherapists. 68,69 For example, research suggests that specialized neurons (mirror neurons) fi re in response to viewing purposeful actions undertaken by others, allowing us to imitate and interpret their intentions by mapping their observed actions onto our own premotor cortex.…”

“…73,74 Sensemaking can apply to enduring, highly structured teams (eg, a liver transplant team), as well as more loosely constructed communities of care (eg, a primary care physician's referral network). 60,61,75,76 The products of sensemaking (eg, shared meaning) in turn can infl uence subsequent understanding and decisions. This iterative process can help participants appreciate new perspectives, meaningfully discuss values and preferences, and inhibit a common tendency of individuals and groups to oversimplify complex situations and processes.…”

Designing a curriculum for communication skills training from a theory and evidence-based perspective

“…Thus, communication behavior related to describing, negotiating, and fulfilling one another's respective roles and responsibilities is equally important in building strong therapeutic relationships [30]. Bachmann et al's list includes a number of skills related to building a relational bond.…”

Insights from a conference on implementing comparative effectiveness research through shared decision-making

“…In addition, they encouraged researchers to consider whether SDM protects clinicians from malpractice suits given that one barrier to engaging in SDM is fear of legal liability [29,30]. Finally, they suggested research on SDM as used across teams of clinicians since many health decisions are complex and are often made across a series of conversations [33,62,63]. …”