title: Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer.
abstract: Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Sarah F
authors: SF
authors: D'Ambruoso
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Anne
authors: A
authors: Coscarelli
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Sara
authors: S
authors: Hurvitz
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Neil
authors: N
authors: Wenger
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: David
authors: D
authors: Coniglio
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Dusty
authors: D
authors: Donaldson
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Christopher
authors: C
authors: Pietras
authors: David Geffen School of Medicine at University of California, Los Angeles (UCLA); Simms/Mann UCLA Center for Integrative Oncology; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles; RAND Corporation, Santa Monica, CA; Campbell University College of Pharmacy and Health Sciences, Buies Creek; and Dusty Joy Foundation (LiveLung), High Point, NC.
authors: Anne M
authors: AM
authors: Walling
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D008960:Models, Psychological; D010166:Palliative Care; D010348:Patient Care Team / Q000458:organization & administration*; D000070659:Patient Comfort; D018802:Patient-Centered Care / Q000458:organization & administration