End-of-life Care and Interprofessional Communication: Not Simply a Matter of "More"

INTRODUCTION A well-functioning interprofessional team has been identified as a central requirement for high quality palliative care. In particular, interprofessional communication and teamwork have been directly linked to patient and family health outcomes. However, evidence suggests that substandard communication and team collaboration between healthcare providers is a persistent challenge that is heightened during palliative care in in-patient settings. This research examined the mechanisms of communication that shaped and impeded interprofessional team practice and coordinated palliative care on acute medical and long-term care units. METHODS This participatory action research project was informed by planned-action and educative-research strategies. The research team worked with healthcare practitioners who cared for dying people in acute and long-term care settings to develop and change practices and institutional arrangements through concurrent phases of ongoing analysis, dialogue, action, and reflection. Data-gathering methods included audio-recorded baseline interviews, observations and on site interactions with field notes, focused group discussions, and meetings. All data was coded using NVivo 9 and a subsequent second level analysis was conducted using Critical Discourse Analysis and Relational Inquiry as an analytical framework. FINDINGS Two main findings included (a) the way in which participants drew upon socio-cultural knowledge to structure and enact communication processes and to describe and interpret their communication experiences within the team, and (b) four recurring relational disjunctures in which conflicting and/or competing messages, goals, or processes hindered the flow and processes of communication and interprofessional team practice. CONCLUSION Given the way in which ideologies and normative practices shape and contribute to ineffective communicative patterns, the findings suggest that the issue is not only how much communication is happening, but the nature of that communication. Thus, addressing the conflicting and/or competing messages, goals, or processes shaping the flow and processes of communication within the interprofessional team is necessary. In particular, explicitly addressing the complex interplay between autonomous professional practice and interprofessional team collaboration is a crucial step in supporting more effective communication and team cohesion. Received: 04/24/2012 Accepted: 06/13/2012 Published: 09/24/2012 © 2012 Doane et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & End-of-Life Care ORIGINAL RESEARCH 1(3):eP1028 | 2 Introduction Research has shown that high-quality palliative care requires a coordinated interprofessional team approach. However, while interprofessional communication and teamwork have been directly linked to patient and family health outcomes (Leathard, 1994), evidence suggests that substandard communication and team collaboration between healthcare providers is a persistent challenge (Bokhour, 2006; Bronstein, 2003; DeLoach, 2003; Reese & Sontag, 2001; Wittenberg-Lyles, Parker Oliver, Demiris, & Courtney, 2009). This challenge is particularly heightened during palliative care in inpatient settings. Building upon previous research findings that illuminated the need for more coordinated palliative care in acute medical and long-term care (LTC) settings (Bern-Klug, 2004; Stadjuhar & Davies, 2005), a participatory action research (PAR) project was undertaken to actively engage interprofessional team members in addressing this need. Included in this research was an investigation of the communication patterns that were occurring within the interprofessional team, with a particular emphasis on examining the discursive practices, social relations, and established patterns of interaction and the impact of those processes on palliative care goals.