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



      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.


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


      This cross-sectional multiphase qualitative study included 23 semi-structured 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.


      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.


      The study informs future interventions to improve the quality of care for seriously ill patients by better-involving palliative care 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.


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