Textbook of Palliative Care Communication

1. Textbook of Palliative Care Communication Section VI: Team Communication

2. Chapter Thirty-Nine Acute care setting

3. Teams in the Acute Care Setting • Emergency Department • Clarification of expectations • General Inpatient Non-ICU setting • Consultation-based assessment of patient goals of care and personal values • Intensive Care Unit • Family meetings • Surrogate decision-making

4. Effective Team Dynamics • Team members have clear roles • Collaborative decision-making • Patient/family member information received is consistent • Family meetings are organized and well planned • Constructive feedback is appreciated

5. SPIKES A roadmap for breaking bad news • Setting –prepare for the meeting • Perception –assess the patient’s understanding of the clinical situation • Invitation – ask permission to engage in conversation about a sensitive topic – this demonstrates respect • Knowledge –the information the team wishes to convey • Empathy – helping the patient see through the fog of his/her emotions and responding with empathy • Strategy/ Summary –summarize what was discussed

6. NURSEHow to respond to emotion • Name the emotion – “It sounds like this has been overwhelming…” • Understand the emotion – “I can’t imagine how hard this must be for you.” • Respect the patient/family – “You are an amazing advocate for your father.” • Support the patient/family – “We will be here for you and your father.” • Explore the emotion – “What other things are you worried about?”

7. Chapter Forty outpatient care setting

8. Palliative Care Home Services • Communication Opportunities • Home visits provides environment for meaningful communication • Patient may feel more powerful and relaxed, inclined to share more • Provider has ability to see and understand patient values (objects, people present) • Opportunity to speak to family members who are not able to be at the hospital

9. Transfer from hospital to home • Key information to consider • Patient’s clinical and social history, including key family members • Insights on patient’s personality, coping, values, hopes • Assessment of patient understanding • Inpatient team’s expectation of the home-based service and how they have described the service to the patient

10. Palliative Care Outpatient Clinic • Communication Opportunities • Early engagement in disease trajectory • Barriers • Time and privacy • Electronic medical record may only be available to those within institution, not at Outpatient Clinic

11. Multidisciplinary Cancer or Tumor Board Meetings • Meetings rarely consider approaches that are not disease-specific therapies; participants likely to have a heavily medical perspective • Palliative Care Provider Role • Report on known patients to communicate referrals/salient information • Encourage early palliative care referral • Encourage focus on quality of life factors, symptoms • Challenge to keep track of agenda and ensure knowledge of patients discussed

12. Chapter Forty-One Hospice Setting

13. Hospice • A ‘total care’ approach that requires expertise from a variety of disciplines • Total care addresses psychological, physical, social, and spiritual aspects of care planning • Team communication and coordination are integral to achieving total care • Not clear how team should work or who should be members of team

14. Team Meetings • Held regularly to enable team member collaboration • Case manager, often a nurse, leads meetings and presents case • Person-centered care is created by team members working across professional boundaries

15. Barriers to Teamwork • Team members may be protective of their area of expertise and reluctant to collaborate • Team members may be critical about hard-to-help patients • Case presentation of patient/family may influence care planning

16. Team Talk • Talk among colleagues in team meetings • Case presentation should be: • Shaped as a mystery story, so that the team focuses on problem-solving • Professional neutralism, distance yourself from problem and focus on objectivity • Remain neutral

17. Future Research • Team meetings rarely include patients and family caregivers; consider possible advantages from inclusion • Little research has addressed team processes’ effect on patient and family outcomes • Varying models of teams exist; research is needed to examine costs and quality of collaboration

18. Chapter Forty-Two Long-term care setting

19. Palliative Care in Nursing Homes • Specific licensing requirements for end of life care in nursing homes • CMS regulations for team collaboration and pain management • Interdisciplinary team, in collaboration with nursing home team, must collaborate about feeding tube placement • Requirement that all residents have the right to execute an advance directive

20. Palliative Care Communication in the Nursing Home • Briefs or Huddles • Quick staff meeting for immediate problem-solving • Debriefs • Short, informal information exchange held after an event or at the end of shift • Daily stand-up meetings • At the start of each day, to identify goals, support improvement, reinforce team focus

21. Palliative Care Communication in the Nursing Home • Situation-Background-Assessment-Recommendation (SBAR) • Standardized communication format for providing information about a resident’s condition • Check-back • Validating information exchanged (confirming receipt) • Call-out • Communicating critical information about a resident during an emergency

22. Palliative Care Communication in the Nursing Home • Handoffs • Sharing pertinent information to other team members; at end of shift or when new team member needs to be updated • Resident Rounds • Identification of residents at high risk of emergency event or chronic pain • Practice Tools • Formal tools to assist with advance care planning, decision-support