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Textbook of Palliative Care Communication
Section VI: Team Communication
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Chapter Thirty-Nine Acute care setting
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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
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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
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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
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NURSE How 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?”
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outpatient care setting
Chapter Forty outpatient care setting
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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
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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
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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
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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
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Chapter Forty-One Hospice Setting
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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
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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
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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
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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
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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
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Long-term care setting
Chapter Forty-Two Long-term care setting
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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
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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
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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
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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
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