Textbook of Palliative Care Communication Section VI Team

Textbook of Palliative Care Communication Section VI: Team Communication

Chapter Thirty-Nine ACUTE CARE SETTING

Teams in the Acute Care Setting • Emergency Department – Clarification of expectations • General Inpatient Non-ICU setting – Consultation-based assessment of patient goals of care and personal values • Intensive Care Unit – Family meetings – Surrogate decision-making

Effective Team Dynamics • Team members have clear roles • Collaborative decision-making • Patient/family member information received is consistent • Family meetings are organized and well planned • Constructive feedback is appreciated

SPIKES A roadmap for breaking bad news • Setting –prepare for the meeting • Perception –assess the patient’s understanding of the clinical situation • Invitation – ask permission to engage in conversation about a sensitive topic – this demonstrates respect • Knowledge –the information the team wishes to convey • Empathy – helping the patient see through the fog of his/her emotions and responding with empathy • Strategy/ Summary –summarize what was discussed

NURSE How to respond to emotion • Name the emotion – “It sounds like this has been overwhelming…” • Understand the emotion – “I can’t imagine how hard this must be for you. ” • Respect the patient/family – “You are an amazing advocate for your father. ” • Support the patient/family – “We will be here for you and your father. ” • Explore the emotion – “What other things are you worried about? ”

Chapter Forty OUTPATIENT CARE SETTING

Palliative Care Home Services • Communication Opportunities – Home visits provides environment for meaningful communication – Patient may feel more powerful and relaxed, inclined to share more – Provider has ability to see and understand patient values (objects, people present) – Opportunity to speak to family members who are not able to be at the hospital

Transfer from hospital to home • Key information to consider – Patient’s clinical and social history, including key family members – Insights on patient’s personality, coping, values, hopes – Assessment of patient understanding – Inpatient team’s expectation of the home-based service and how they have described the service to the patient

Palliative Care Outpatient Clinic • Communication Opportunities – Early engagement in disease trajectory • Barriers – Time and privacy – Electronic medical record may only be available to those within institution, not at Outpatient Clinic

Multidisciplinary Cancer or Tumor Board Meetings • Meetings rarely consider approaches that are not disease-specific therapies; participants likely to have a heavily medical perspective • Palliative Care Provider Role – Report on known patients to communicate referrals/salient information – Encourage early palliative care referral – Encourage focus on quality of life factors, symptoms • Challenge to keep track of agenda and ensure knowledge of patients discussed

Chapter Forty-One HOSPICE SETTING

Hospice • A ‘total care’ approach that requires expertise from a variety of disciplines – Total care addresses psychological, physical, social, and spiritual aspects of care planning • Team communication and coordination are integral to achieving total care – Not clear how team should work or who should be members of team

Team Meetings • Held regularly to enable team member collaboration • Case manager, often a nurse, leads meetings and presents case • Person-centered care is created by team members working across professional boundaries

Barriers to Teamwork • Team members may be protective of their area of expertise and reluctant to collaborate • Team members may be critical about hard-tohelp patients • Case presentation of patient/family may influence care planning

Team Talk • Talk among colleagues in team meetings • Case presentation should be: – Shaped as a mystery story, so that the team focuses on problem-solving – Professional neutralism, distance yourself from problem and focus on objectivity – Remain neutral

Future Research • Team meetings rarely include patients and family caregivers; consider possible advantages from inclusion • Little research has addressed team processes’ effect on patient and family outcomes • Varying models of teams exist; research is needed to examine costs and quality of collaboration

Chapter Forty-Two LONG-TERM CARE SETTING

Palliative Care in Nursing Homes • Specific licensing requirements for end of life care in nursing homes – CMS regulations for team collaboration and pain management – Interdisciplinary team, in collaboration with nursing home team, must collaborate about feeding tube placement – Requirement that all residents have the right to execute an advance directive

Palliative Care Communication in the Nursing Home • Briefs or Huddles – Quick staff meeting for immediate problemsolving • Debriefs – Short, informal information exchange held after an event or at the end of shift • Daily stand-up meetings – At the start of each day, to identify goals, support improvement, reinforce team focus

Palliative Care Communication in the Nursing Home • Situation-Background-Assessment. Recommendation (SBAR) – Standardized communication format for providing information about a resident’s condition • Check-back – Validating information exchanged (confirming receipt) • Call-out – Communicating critical information about a resident during an emergency

Palliative Care Communication in the Nursing Home • Handoffs – Sharing pertinent information to other team members; at end of shift or when new team member needs to be updated • Resident Rounds – Identification of residents at high risk of emergency event or chronic pain • Practice Tools – Formal tools to assist with advance care planning, decision-support