Interdisciplinary Palliative Care Teams

2019 ◽  
pp. 89-97
Author(s):  
Polly Mazanec ◽  
Rebekah Reimer ◽  
Jessica Bullington ◽  
Patrick J. Coyne ◽  
Herman Harris ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interdisciplinary Team ◽  
Palliative Care Team ◽  
Care Team ◽  
Patient Centered ◽  
Team Members ◽  
Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

Integration of spiritual care into palliative care service delivery models

2021 ◽  
pp. 1072-1080
Author(s):  
Yvan Beaussant ◽  
Alexandra Nichipor ◽  
Tracy A. Balboni
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Care Delivery ◽  
Palliative Care Team ◽  
Care Team ◽  
Clear Understanding ◽  
Care Provision ◽  
Serious Illness ◽  
Palliative Care Teams ◽  
Religious Dimensions

Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.

Confidence and skills for cystic fibrosis end-of-life care

2020 ◽  
pp. bmjspcare-2020-002274
Author(s):  
Eva Harris-Skillman ◽  
Stephen Chapman ◽  
Aoife Lowney ◽  
Mary Miller ◽  
William Flight
Keyword(s):  
Cystic Fibrosis ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Further Education ◽  
Palliative Care Team ◽  
Care Team ◽  
Life Care ◽  
Team Members ◽  
Palliative Care Teams

ObjectivesOptimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.MethodsAn electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.Results35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.ConclusionsFew members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.

scholarly journals Narrative and Palliative Care Team Identity Formation

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Denise Hess
Keyword(s):  
Palliative Care ◽  
Identity Formation ◽  
Meaning Making ◽  
Quality Care ◽  
Palliative Care Team ◽  
Care Team ◽  
Spiritual Needs ◽  
Team Identity ◽  
Team Members ◽  
Palliative Care Teams

Palliative care is whole person care that attends to the physical, psychosocial, and spiritual needs of persons with a serious or life-limiting illness. This care is provided by a team of clinicians from several disciplines including physicians, nurses, social workers, and chaplains. The palliative care team functions as a dynamic system whose ability to provide quality care is dependent upon the ability of the team members to form and maintain an ongoing collaborative alliance. This alliance requires that team members maintain dual commitments to both the care receivers and to their fellow team members. Just as persons with illness express the human propensity toward meaning making in the face of suffering, so palliative care teams thrive when they are supported in reflective processes that enhance their ability to find meaning in their work. Creation of and attention to team narratives and their role in team identity formation can enhance team members’ flourishing by placing team identity in the context of a larger story. Narratives of rescuing and fixing foster a sense of control and expertise while narratives of containing and healing nurture attention to mindful presence and human-to-human encounter.

scholarly journals Parental experiences with a paediatric palliative care team: A qualitative study

2017 ◽  
Vol 31 (10) ◽  
pp. 956-963 ◽  
Author(s):  
Lisa M Verberne ◽  
Antoinette YN Schouten-van Meeteren ◽  
Diederik K Bosman ◽  
Derk A Colenbrander ◽  
Charissa T Jagt ◽  
...  
Keyword(s):  
Palliative Care ◽  
Palliative Care Team ◽  
Care Team ◽  
Multidisciplinary Teams ◽  
Team Members ◽  
Paediatric Palliative Care ◽  
Practical Support ◽  
Qualitative Interview Study ◽  
Palliative Care Teams

Background: Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the family. Yet, little is known about how parents experience such multidisciplinary teams. Aim: To obtain insight into the support provided by a new paediatric palliative care team from the parents’ perspective. Design: An interpretative qualitative interview study using thematic analysis was performed. Setting/participants: A total of 47 single or repeated interviews were undertaken with 42 parents of 24 children supported by a multidisciplinary paediatric palliative care team located at a university children’s hospital. The children suffered from malignant or non-malignant diseases. Results: In advance, parents had limited expectations of the paediatric palliative care team. Some had difficulty accepting the need for palliative care for their child. Once parents experienced what the team achieved for their child and family, they valued the team’s involvement. Valuable elements were as follows: (1) process-related aspects such as continuity, coordination of care, and providing one reliable point of contact; (2) practical support; and (3) the team members’ sensitive and reliable attitude. As a point of improvement, parents suggested more concrete clarification upfront of the content of the team’s support. Conclusion: Parents feel supported by the paediatric palliative care team. The three elements valued by parents probably form the structure that underlies quality of paediatric palliative care. New teams should cover these three valuable elements.

Collective soul: The spirituality of an interdisciplinary palliative care team

2006 ◽  
Vol 4 (1) ◽  
pp. 13-24 ◽  
Author(s):  
SHANE SINCLAIR ◽  
SHELLEY RAFFIN ◽  
JOSE PEREIRA ◽  
NANCY GUEBERT
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Focus Groups ◽  
Health Care Professionals ◽  
Palliative Care Team ◽  
Care Team ◽  
Cancer Center ◽  
Team Members ◽  
Spiritual Journeys ◽  
Common Goals

Objective:Although spirituality as it relates to patients is gaining increasing attention, less is known about how health care professionals (HCP) experience spirituality personally or collectively in the workplace. This study explores the collective spirituality of an interdisciplinary palliative care team, by studying how individuals felt about their own spirituality, whether there was a shared sense of a team spirituality, how spirituality related to the care the team provided to patients and whether they felt that they provided spiritual care.Methods:A qualitative autoethnographic approach was used. The study was conducted in a 10-bed Tertiary Palliative Care Unit (TPCU) in a large acute-care referral hospital and cancer center. Interdisciplinary team members of the TPCU were invited to participate in one-to-one interviews and/or focus groups. Five interviews and three focus groups were conducted with a total of 20 participants.Results:Initially participants struggled to define spirituality. Concepts of spirituality relating to integrity, wholeness, meaning, and personal journeying emerged. For many, spirituality is inherently relational. Others acknowledged transcendence as an element of spirituality. Spirituality was described as being wrapped in caring and often manifests in small daily acts of kindness and of love, embedded within routine acts of caring. Palliative care served as a catalyst for team members' own spiritual journeys. For some participants, palliative care represented a spiritual calling. A collective spirituality stemming from common goals, values, and belonging surfaced.Significance of results:This was the first known study that focused specifically on the exploration of a collective spirituality. The culture of palliative care seems to foster spiritual reflection among health care professionals both as individuals and as a whole. While spirituality was difficult to describe, it was a shared experience often tangibly present in the provision of care on all levels.

An Active In-Home Physician Model of Palliative Care and Its Resulting Performance Indicators Related to Home Deaths, Unplanned Emergency Department Visits and Unplanned Hospital Admissions

2020 ◽  
Vol 36 (1) ◽  
pp. 46-49
Author(s):  
Colleen Webber ◽  
Aurelia Ona Valiulis ◽  
Peter Tanuseputro ◽  
Valerie Schulz ◽  
Tavis Apramian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Hospital Admissions ◽  
Case Series ◽  
Palliative Care Team ◽  
Emergency Department Visits ◽  
Care Team ◽  
Retrospective Case ◽  
Palliative Care Teams ◽  
Unplanned Hospital Admissions

Background: Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams. Case presentation: A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019. Case management: The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization. Case outcomes: In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% ( n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% ( n = 75) patients visited an emergency department and 24.6% ( n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively. Conclusion: The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.

Interdisciplinary Education in Palliative Care: A Bold Strategy, Solution and Political Statement

2012 ◽  
Vol 20 (4) ◽  
pp. 375-386 ◽  
Author(s):  
Susan Breiddal
Keyword(s):  
Palliative Care ◽  
Care Setting ◽  
Ways Of Knowing ◽  
Palliative Care Team ◽  
Care Team ◽  
Interdisciplinary Education ◽  
Team Members ◽  
Palliative Care Setting ◽  
Political Statement ◽  
Health Canada

Harsh experience reveals that preparing the interdisciplinary palliative care team members cannot be accomplished by sequestering students in single-discipline training. By combining different ways of knowing and being that are the underlying tenets of interdisciplinary education, we must—by design, curriculum, teaching strategies, and research—reflect the nature and practice of the interdisciplinary palliative care team. This kind of education is an imperative if we are going to meet our own goals to provide physical, emotional, and spiritual care to people at end-of-life. As educators, we must take to heart the responsibility to prepare students with the skills to apply their knowledge within the context of the palliative care setting, as practiced by the interdisciplinary team. This position is supported in the literature, is recommended by Health Canada, and is affirmed by experience in the field.

scholarly journals Palliative medicine in the intensive care unit: needs, delivery, quality

2021 ◽  
pp. bmjspcare-2020-002795
Author(s):  
Stephanie A Hill ◽  
Abdul Dawood ◽  
Elaine Boland ◽  
Hannah E Leahy ◽  
Fliss EM Murtagh
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Care Delivery ◽  
Multiorgan Failure ◽  
Symptom Control ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Treatment Limitation

Background15%–20% of critical care patients die during their hospital admission. This service evaluation assesses quality of palliative care in intensive care units (ICUs) compared with national standards.MethodsRetrospective review of records for all patients who died in four ICUs (irrespective of treatment limitation) between 1 June and 31 July 2019. Descriptive statistics reported for patient characteristics, length of stay, admission route, identification triggers and palliative care delivery.ResultsForty-five patients died, two records were untraced, thus N=43. The dying process was recognised in 88% (n=38). Among those where dying was recognised (N=35), 97% (34) had documented family discussion before death, 9% (3) were offered religious/spiritual support, 11% (4) had review of hydration/nutrition and 6% (2) had documented preferred place of death. Prescription of symptom control medications was complete in 71% (25) opioids, 34% (12) haloperidol, 54% (19) midazolam and 43% (15) hyoscine. Combining five triggers—length of stay >10 days prior to ICU admission 7% (3), multiorgan failure ≥3 systems 33% (14), stage IV malignancy 5% (2), post-cardiac arrest 23% (10) and intracerebral haemorrhage requiring mechanical ventilation 12% (5)—identified 60% (26) of patients. Referral to the palliative care team was seen in 14% (5), and 8% (3) had specialist palliative care team review.ConclusionsRecognition of dying was high but occurred close to death. Family discussions were frequent, but religious/spiritual needs, hydration/nutrition and anticipatory medications were less often considered. The ICUs delivered their own palliative care in conjunction with specialist palliative care input. Combining five triggers could increase identification of palliative care needs, but a larger study is needed.

Occupational therapy and physiotherapy interventions in palliative care: a cross-sectional study of patient-reported needs

2020 ◽  
pp. bmjspcare-2020-002337
Author(s):  
Nina Høgdal ◽  
Inge Eidemak ◽  
Per Sjøgren ◽  
Henrik Larsen ◽  
Jonas Sørensen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Occupational Therapy ◽  
Unmet Needs ◽  
Occupational Therapists ◽  
Interdisciplinary Team ◽  
Physical Activities ◽  
Palliative Care Team ◽  
Care Team ◽  
Daily Activities ◽  
Patient Reported

IntroductionAn interdisciplinary team approach to patients in specialised palliative care is recommended; however, the composition of the professionals tends to vary, and the roles of physiotherapists and occupational therapists may be underestimated. We aimed to investigate patient-reported unmet needs, which potentially could benefit from physiotherapy and occupational therapy interventions in a specialised palliative care team.MethodsAdult patients with chronic advanced diseases referred to the Specialised Palliative Care Team at Copenhagen University Hospital, Rigshospitalet were enrolled in the study. The Three-Levels-of-Needs Questionnaire was used as primary outcome to assess symptom/problem intensity, symptom/problem burden and felt needs for 12 commonly reported symptoms/problems for patients referred to a specialised palliative care team. Furthermore, participants’ level of distress, fatigue and physical activity, symptoms of anxiety and depression, and barriers towards the rehabilitation programme were registered with other measures.ResultsIn total, 43 of 67 (64%) patients participated. The majority of participants reported severe symptoms/problems concerning fatigue (81%), impaired physical activities (77%), carrying out work and daily activities (77%), pain (72%), and worries (58%). Furthermore, need for help was expressed concerning physical activities (79%), work and daily activities (77%), fatigue (70%), pain (65%), concentration (58%) and worries (51%). On average the patients characterised 6 (out of 12) symptoms/problems as severe.ConclusionPatients referred to a specialised palliative care team reported extensive unmet needs concerning physical activities, work and daily activities, fatigue, pain, concentration and worries. Unmet needs that potentially could be alleviated by physiotherapists or occupational therapists implemented in the interdisciplinary team.

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