title: An exploratory study of interprofessional collaboration in end-of-life decision-making beyond palliative care settings.
abstract: As healthcare delivery becomes increasingly interprofessional, it is imperative to identify opportunities for effective collaboration and coordination of care. Drawing on a Canadian qualitative study that adopted a constant comparative method based on the grounded theory approach, we report how healthcare providers' (HCPs) personal experiences and professional roles intersect with system factors in hindering or enhancing their ability to support patients and families in planning for end-of-life (EOL) care. We used a criterion-based sampling strategy and sought HCPs who had direct experience engaging patients and families in complex healthcare decisions on: (1) initiating, withholding, or withdrawing treatment; (2) care planning; and/or (3) discharge planning. Interviews sought to understand what HCPs perceived as individual, (inter)professional, and system factors that might hinder, promote, or enhance support for patients/families. We present four major intersecting themes from in-depth interviews with 28 HCPs across acute, long-term, and community care settings that represent three barriers and one facilitator: discomfort with death and dying, confusion about role responsibility, lack of coordinated care, and importance of interprofessional teamwork. Attending to system power hierarchy, we explore interprofessional strategies to support patients' and families' care experiences and promote team-based decision-making. We recommend an interprofessional team approach to facilitate EOL decision-making across care settings and before death becomes imminent. Increasing educational initiatives and developing tools that focus on interprofessional collaboration may help HCPs to understand each other's roles and perspectives, so that they can work together to provide a more coherent and coordinated approach to EOL decision-making.
authors.affiliation: a Centre for Biomedical Ethics, Yong Loo Lin School of Medicine , National University of Singapore , Singapore.|b Centre for Applied Ethics , University of British Columbia , Vancouver , British Columbia , Canada.|c Providence Health Care , Vancouver , British Columbia , Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Ho
authors.affiliation: b Centre for Applied Ethics , University of British Columbia , Vancouver , British Columbia , Canada.|d Vancouver Coastal Health , Vancouver , British Columbia , Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Jameson
authors.affiliation: e School of Nursing , University of California, Los Angeles , Los Angeles , California , USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Pavlish
mesh_terms: D002170:Canada; D003657:Decision Making; D006801:Humans; D010166:Palliative Care; D036301:Qualitative Research; D013727:Terminal Care
keywords: Advance care planning; end-of-life care; healthcare provider perspectives; interprofessional communication; palliative care; qualitative methods; role clarity; treatment decision-making