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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pain and Symptom ManagementAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
- 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
- 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
- Palliative care in surgery: defining the research priorities.Ann Surg. 2018; 267: 66-72https://doi.org/10.1097/SLA.0000000000002253
- Palliative care and end-of-life outcomes following high-risk surgery.JAMA Surg. 2020; 155: 138-146https://doi.org/10.1001/jamasurg.2019.5083
- 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
- Palliative care interventions for surgical patients: a systematic review.JAMA Surg. 2016; 151: 172-183https://doi.org/10.1001/jamasurg.2015.3625
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Teamwork: a concept analysis.J Adv Nurs. 2008; 61: 232-241https://doi.org/10.1111/j.1365-2648.2007.04496.x
- 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
- 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
- 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
- Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors.J Public Health. 2014; 37: 716-727
- 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
- 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
- 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
- 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
- Qualitative research & evaluation methods: integrating theory and practice. SAGE publications, United States2014
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
- Computing inter-rater reliability for observational data: an overview and tutorial.Tutor Quant Methods Psychol. 2012; 8: 23-34
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.
IM Rubin, RE Fry and MS Plovnick, Managing human resources in health care organizations: An applied approach, 1978, Reston Publishing Company, United States.
- Leading teams: Setting the stage for great performances. Harvard Business Press, Boston2002
- Characteristics of effective teams: a literature review.Aust Health Rev. 2000; 23: 201https://doi.org/10.1071/AH000201
- 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
- Interprofessional teamworking: what makes teams work well?.J Interprof Care. 2001; 15: 29-35https://doi.org/10.1080/13561820020022855
- 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
- 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
- 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
- What affects adoption of specialty palliative care in intensive care units: a qualitative study.J Pain Symptom Manage. 2021; 62: 1273-1282
- 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
Article info
Publication history
Published online: January 13, 2023
Accepted:
December 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
