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“It's Not Us Versus Them”: Building Cross-Disciplinary Relationships in the Perioperative Period

      Abstract

      Context

      Palliative care (PC) interventions improve quality outcomes for surgical patients, yet they are underutilized in the perioperative period. Developing cross-disciplinary provider relationships increases PC consults. However, the attributes of collaborative relationships and how they evolve are unclear.

      Objectives

      To identify perceptions of PC providers and surgeons on how collaborative cross-disciplinary relationships are built and maintained in the perioperative period.

      Methods

      This cross-sectional multiphase qualitative study included 23 semistructured interviews with 10 PC teams (20 providers) and 13 surgeons at geographically distributed Veteran Health Administration (VHA) sites. An analytic approach relied on team-based thematic analysis with a dual review (Krippendorf α above 0.8).

      Results

      Respondents defined successful collaborative work relationships between PC and surgeons as having the following features: 1) mutual trust; 2) mutual respect; 3) perceived usefulness; 4) shared clinical objectives; 5) effective communication; and 6) organizational enablers. In addition, the analysis elucidated a framework of six strategies for developing collaborative relationships between PC and surgical teams in the perioperative period: 1) being present, available, and responsive; 2) understanding roles; 3) establishing communication; 4) recognizing an intermediary and connecting role of supporting team members; 5) working as a team; and 6) building on previous experiences.

      Conclusion

      The study informs future interventions to improve the quality of care for seriously ill patients by better-involving PC in the perioperative period. Future work will extend this approach to incorporate the perspectives of patients on their providers’ collaboration and how it impacts patient-related outcomes at the intersection of PC and surgery.

      Key Words

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      References

        • Rodriguez KL
        • Barnato AE
        • Arnold RM
        Perceptions and utilization of palliative care services in acute care hospitals.
        J Palliat Med. 2007; 10: 99-110https://doi.org/10.1089/jpm.2006.0155
        • Mosenthal AC
        • Weissman DE
        • Curtis JR
        • et al.
        Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care.
        Crit Care Med. 2012; 40: 1199-1206https://doi.org/10.1097/CCM.0b013e31823bc8e7
        • Singer AE
        • Goebel JR
        • Kim YS
        • et al.
        Populations and interventions for palliative and end-of-life care: a systematic review.
        J Palliat Med. 2016; 19: 995-1008https://doi.org/10.1089/jpm.2015.0367
        • Lilley EJ
        • Cooper Z
        • Schwarze ML
        • et al.
        Palliative care in surgery: defining the research priorities.
        Ann Surg. 2018; 267: 66-72https://doi.org/10.1097/SLA.0000000000002253
        • Yefimova M
        • Aslakson RA
        • Yang L
        • et al.
        Palliative care and end-of-life outcomes following high-risk surgery.
        JAMA Surg. 2020; 155: 138-146https://doi.org/10.1001/jamasurg.2019.5083
        • Greer JA
        • Tramontano AC
        • McMahon PM
        • et al.
        Cost analysis of a randomized trial of early palliative care in patients with metastatic nonsmall-cell lung cancer.
        J Palliat Med. 2016; 19: 842-848https://doi.org/10.1089/jpm.2015.0476
        • Lilley EJ
        • Khan KT
        • Johnston FM
        • et al.
        Palliative care interventions for surgical patients: a systematic review.
        JAMA Surg. 2016; 151: 172-183https://doi.org/10.1001/jamasurg.2015.3625
        • May P
        • Normand C
        • Morrison RS.
        Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research.
        J Palliat Med. 2014; 17: 1054-1063https://doi.org/10.1089/jpm.2013.0594
        • Moorhouse P
        • Mallery LH.
        Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults.
        J Am Geriatr Soc. 2012; 60: 2326-2332https://doi.org/10.1111/j.1532-5415.2012.04210.x
        • Ernst KF
        • Hall DE
        • Schmid KK
        • et al.
        Surgical palliative care consultations over time in relationship to systemwide frailty screening.
        JAMA Surg. 2014; 149: 1121-1126https://doi.org/10.1001/jamasurg.2014.1393
        • Bakitas MA
        • Tosteson TD
        • Li Z
        • et al.
        Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial.
        J Clin Oncol. 2015; 33: 1438-1445https://doi.org/10.1200/JCO.2014.58.6362
        • Wachterman MW
        • Pilver C
        • Smith D
        • et al.
        Quality of end-of-life care provided to patients with different serious illnesses.
        JAMA Intern Med. 2016; 176: 1095-1102https://doi.org/10.1001/jamainternmed.2016.1200
        • Evans BA
        • Turner MC
        • Gloria JN
        • et al.
        Palliative Care Consultation is underutilized in critically ill general surgery patients.
        Am J Hosp Palliat Med. 2020; 37: 149-153https://doi.org/10.1177/1049909119864025
        • Kross EK
        • Engelberg RA
        • Downey L
        • et al.
        Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians.
        Chest. 2014; 145: 313-321https://doi.org/10.1378/chest.13-1351
        • Olmsted CL
        • Johnson AM
        • Kaboli P
        • et al.
        Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration.
        JAMA Surg. 2014; 149: 1169-1175https://doi.org/10.1001/jamasurg.2014.2101
        • Conn LG
        • Haas B
        • Cuthbertson BH
        • et al.
        Communication and culture in the surgical intensive care unit: boundary production and the improvement of patient care.
        Qual Health Res. 2016; 26: 895-906https://doi.org/10.1177/1049732315609901
        • Xyrichis A
        • Ream E.
        Teamwork: a concept analysis.
        J Adv Nurs. 2008; 61: 232-241https://doi.org/10.1111/j.1365-2648.2007.04496.x
        • Tremblay D
        • Roberge D
        • Touati N
        • et al.
        Effects of interdisciplinary teamwork on patient-reported experience of cancer care.
        BMC Health Serv Res. 2017; 17: 218https://doi.org/10.1186/s12913-017-2166-7
        • Matthys E
        • Remmen R
        • Van Bogaert P
        An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?.
        BMC Fam Pract. 2017; 18: 110https://doi.org/10.1186/s12875-017-0698-x
        • Hall P
        • Weaver L
        Interdisciplinary education and teamwork: a long and winding road.
        Med Educ. 2001; 35: 867-875https://doi.org/10.1046/j.1365-2923.2001.00919.x
        • Supper I
        • Catala O
        • Lustman M
        • et al.
        Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors.
        J Public Health. 2014; 37: 716-727
        • McDarby M
        • Carpenter BD.
        Barriers and facilitators to effective inpatient palliative care consultations: a qualitative analysis of interviews with palliative care and nonpalliative care providers.
        Am J Hosp Palliat Med. 2019; 36: 191-199https://doi.org/10.1177/1049909118793635
        • Giannitrapani K
        • McCaa M
        • Sasnal M
        • et al.
        Strategies to improve perioperative quality of care through palliative care (S525).
        J Pain Symptom Manage. 2022; 63: 918-919https://doi.org/10.1016/j.jpainsymman.2022.02.148
        • Mittel A
        • Kim DH
        • Cooper Z
        • et al.
        Use of 90-day mortality does not change assessment of hospital quality after coronary artery bypass grafting in New York State.
        J Thorac Cardiovasc Surg. 2022; 163: 676-682.e1https://doi.org/10.1016/j.jtcvs.2020.03.072
        • Schwarze ML
        • Brasel KJ
        • Mosenthal AC
        Beyond 30-day mortality: aligning surgical quality with outcomes that patients value.
        JAMA Surg. 2014; 149: 631-632https://doi.org/10.1001/jamasurg.2013.5143
        • Patton MQ
        Qualitative research & evaluation methods: integrating theory and practice. SAGE publications, United States2014
        • Braun V
        • Clarke V
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
        • Hallgren KA.
        Computing inter-rater reliability for observational data: an overview and tutorial.
        Tutor Quant Methods Psychol. 2012; 8: 23-34
      1. LS Nowell, JM Norris, DE White, et al., Thematic analysis: striving to meet the trustworthiness criteria, Int J Qual Methods, 16, 2017, 1-13, 1609406917733847, doi:10.1177/1609406917733847.

      2. IM Rubin, RE Fry and MS Plovnick, Managing human resources in health care organizations: An applied approach, 1978, Reston Publishing Company, United States.

        • Hackman JR
        • Hackman RJ
        Leading teams: Setting the stage for great performances. Harvard Business Press, Boston2002
        • Mickan S
        • Rodger S
        Characteristics of effective teams: a literature review.
        Aust Health Rev. 2000; 23: 201https://doi.org/10.1071/AH000201
        • Lanham HJ
        • McDaniel RR
        • Crabtree BF
        • et al.
        How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.
        Jt Comm J Qual Patient Saf. 2009; 35: 457-AP2https://doi.org/10.1016/S1553-7250(09)35064-3
        • Molyneux J.
        Interprofessional teamworking: what makes teams work well?.
        J Interprof Care. 2001; 15: 29-35https://doi.org/10.1080/13561820020022855
        • Firn J
        • Preston N
        • Walshe C
        What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams? A systematically constructed narrative synthesis.
        Palliat Med. 2016; 30: 240-256https://doi.org/10.1177/0269216315615483
        • Albers G
        • Froggatt K
        • Van den Block L
        • et al.
        A qualitative exploration of the collaborative working between palliative care and geriatric medicine: barriers and facilitators from a European perspective.
        BMC Palliat Care. 2016; 15: 47https://doi.org/10.1186/s12904-016-0118-3
        • Dudley N
        • Ritchie CS
        • Rehm RS
        • et al.
        Facilitators and barriers to interdisciplinary communication between providers in primary care and palliative care.
        J Palliat Med. 2019; 22: 243-249https://doi.org/10.1089/jpm.2018.0231
        • Hua M
        • Fonseca LD
        • Morrison RS
        • et al.
        What affects adoption of specialty palliative care in intensive care units: a qualitative study.
        J Pain Symptom Manage. 2021; 62: 1273-1282
        • Giannitrapani KF
        • Silveira MJ
        • Azarfar A
        • et al.
        Cross disciplinary role agreement is needed when coordinating long-term opioid prescribing for cancer: a qualitative study.
        J Gen Intern Med. 2021; 36: 1867-1874https://doi.org/10.1007/s11606-021-06747-z