Section III: The Interdisciplinary Team and Family Members

Healthcare Professionals Influence Communication Outcomes Behaviors and communication style Lack of personal experience with death and dying Fear of not knowing the answer Lack of understanding patient’s and family’s end-of-life goals Language barriers

Family Meetings Patient may attend Family members Appropriate clinicians (best to include primary care along with palliative care) Goal to enhance communication

Why are Family Meetings Important? Share information Identify needs/fears Set goals

How Do I Articulate the Way Palliative Care Can Help? Improved clinical care More efficient use of resources Better care coordination Cost avoidance

Timing For Conversation is Critical A good time to talk? Is there a need to talk? Has someone else from the interdisciplinary team already spoken with the patient/family? Is there an “overload” of information? Is patient experiencing pain/other symptoms? Caregiver may be exhausted Dahlin & Wittenberg, 2015

Team Communication Intra-team communication is vital, especially between RN and MD Should be collaborative Should be effective and frequent Document Expect conflicts

When You Have a Team of More Than One, Expect Conflict Try to take a step back Identify your own emotions Define the conflict Obtain agreement on the conflict Talk about it Patient’s best interest should always be foremost Dahlin & Wittenberg, 2015; Goulette, 2007; Jeffrey, 2010

Communication with Physicians Who Are Unfamiliar with Palliative Care Honor the relationship physicians have with their patients Maintain professional relationship Be specific about the reasons for the “ask.” “The nurses on the medical unit state that Mrs. James has pain and dyspnea.” “ Mrs. James’ daughter believes her mother's functional status is declining.” Palliative care can support the work of attending physicians

Communication Vignette: Speaking with Physician Refusing Palliative Care For Patient

Summary Communication is complex The ultimate objective is to advocate for the patient’s wishes Patients and their families must be involved in communication Nurse to promote communication among team members, patients and family