Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study
Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study
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DOI：
10.1089/jpm.2018.0471
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发表时间：
2019-07-01
影响因子：
2.8
通讯作者：
Sanders, Justin
中科院分区：
文献类型：
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作者：
Lakin, Joshua R.;Benotti, Emily;Sanders, Justin
背景资料：有证据表明，临床医生和重病患者之间关于他们的目标和偏好或重病沟通的讨论是一种高价值的干预措施，导致对这一领域的改进需求不断增长。利用跨专业团队解决这一需求的努力是有希望的;然而，我们缺乏对不同专业如何合作以提供更好的严重疾病沟通的深入了解。目的：探讨基层临床医师对重症沟通中跨专业工作的看法。设计：半结构化的关键知情人访谈的定性分析。设置/受试者：在马萨诸塞州波士顿的一家大型学术医疗中心实施结构化初级姑息治疗计划（重病护理计划）的初级护理临床医生（医生、护理协调护士和社会工作者）。结果如下：我们从参与者对计划实施的描述中得出了主要主题和子主题：跨专业团队，护士和个人主动性的重要性和价值;准备和结构在实现高质量沟通中的作用;以及试图改善严重疾病沟通的方式揭示了其他可能限制计划有效性或被视为计划失败的问题。我们得出了一个概念模型，说明了跨专业的团队互动，工作流程和感知程序的结果之间的关系。结论：这项研究提出了三个重点领域的设计和实施方案，旨在改善严重疾病的对话由跨专业的初级保健团队：建立明确的专业角色和责任，特别注意跨专业和临床医生-患者的关系，并明确结构干预措施，旨在改变我们的系统驱动严重疾病的沟通方式。
Background: Evidence demonstrates that discussion between clinicians and seriously ill patients about their goals and preferences, or serious illness communication, is a high-value intervention, resulting in growing demand for improvement in this area. Promising efforts address this demand utilizing interprofessional teams; yet, we lack insight into how different professions work together to deliver better serious illness communication. Objective: To explore the perceptions of primary care clinicians about interprofessional work in serious illness communication. Design: Qualitative analysis of semistructured key informant interviews. Settings/Subjects: Primary care clinicians (physicians, care coordination nurses, and social workers) who have experience implementing a structured primary palliative care program, the Serious Illness Care Program, at a large academic medical center in Boston, Massachusetts. Results: We derived primary themes and subthemes from participant descriptions of program implementation: the importance and value of interprofessional teams, nurses, and individual initiative; the role of preparation and structure in enabling high-quality communication; and the ways in which attempts to improve serious illness communication reveal other problems that can limit program effectiveness or be perceived as program failures. We derived a conceptual model that illustrates the relationships between interprofessional team interactions, workflows, and perceived program outcomes. Conclusions: This study suggests three key areas of focus for design and implementation of programs aimed at improving serious illness conversations by interprofessional primary care teams: establishing clear professional roles and responsibilities, paying special attention to interprofessional and clinician-patient relationships, and clearly structuring interventions aiming to change the way our system drives serious illness communication.