Using Normalisation Process Theory to explore an interprofessional approach to Goals of Care: a qualitative study of stakeholders’ perspectives

ABSTRACT

Goals of Care (GOC) is a longitudinal, multi-setting, and interprofessional practise aiming to guide the use of life-sustaining therapies. We documented the perspectives of different stakeholders regarding their roles in GOC intervention and explored the possibility of implementing an interprofessional approach in a healthcare and social services institution. We interviewed nurses, social workers, and relatives of deceased persons and analyzed the results using an analytical framework based on the 16 mechanisms of the Normalization Process Theory. We identified barriers to implementing a sustainable interprofessional approach to GOC, such as the lack of designated leaders responsible for supporting the day-to-day provision of this rather complex intervention, the difficulty of access to physicians in two of the three care settings under study, and the lack of a robust informational system. We also demonstrated that the GOC intervention is postponed until there is no uncertainty to deal with, i.e., at the end of life. Our study adds to an emerging body of literature criticising the concept of making advance medical directives itself. We advocated for the promotion of tools that would enable lay people to select and empower a supportive decision maker to better represent them in serious illness decision making.

KEYWORDS:

• Advance care planning
• Goals of Care
• Normalization Process Theory
• Interprofessional practice
• Limits of advance medical directives

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by the Canadian Institutes of Health Research.

Notes on contributors

Ariane Plaisance

Ariane Plaisance is a postdoctoral researcher at the University of Quebec in Rimouski, Quebec, Canada. Her research interests include the limits of advance care planning and goals of care, equity in access to palliative care, and community-based research.

Daren K Heyland

Daren K Heyland is a professor of medicine and epidemiology at Queen’s University, Kingston, Ontario Canada. His research interests are end-of-life communication and decision-making at the end of life.

Brigitte Laflamme

Brigitte Laflamme is the director of the Maison Michel-Sarrazin a nursing home in Quebec City, Quebec, Canada. Her research interests include palliative care management and end-of-life communication.

Michèle Morin

Michèle Morin is a professor of medicine at Laval University, Quebec, Canada. Her research interests include geriatrics and ageing in rural areas.

Félix Pageau

Félix Pageau is a professor of medicine at Laval University, Quebec, Canada. His research interests include ethics, geriatrics, and end-of-life decision making.

Ariane Girard

Ariane Girard is a professor of nursing at the University of Sherbrooke, Quebec, Canada. Her research interests include interprofessional practices and mental health.

Annie LeBlanc

Annie LeBlanc is a professor at the faculty of medicine at Laval University, Quebec, Canada. Her research interests are in shared decision making and patient-centered research.