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.

KEYWORDS:

• Advance care planning
• end-of-life care
• healthcare provider perspectives
• interprofessional communication
• palliative care
• qualitative methods
• role clarity
• treatment decision-making

Acknowledgements

We thank Dr. Dave Unger as well as the reviewers and the editor for their helpful comments on earlier versions of this article. We also thank the healthcare providers who volunteered their time to participate in this research.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

The authors thank the Canadian Institutes of Health Research and Providence Health Care for funding and logistical support for this research.

Additional information

Funding

The authors thank the Canadian Institutes of Health Research and Providence Health Care for funding and logistical support for this research.