Palliative Care and Communication Issues for the interdisciplinary

Question: Discuss about the Palliative Care and Communication Issuesfor the interdisciplinary Practice. Answer: Introduction As defined by the World Health Organization palliative care is an approach undertaken for terminally ill patients in order to provide optimum level of care and support to the patients in a collaborative manner. It addresses the physical, psychosocial as well as the spiritual aspects of a patient (WHO | WHO Definition of Palliative Care, 2017). The whole approach aims to enhance the quality of life of the patient and to make death a relatively normal process, throughout the course of the illness. Several standards have been laid out to ensure quality palliative care and services. Focusing on subject cantered care and decision-making based on specific needs of the patients and their family; maintaining and respecting the moral and spiritual values of the patient and efficient communication between the different stakeholders associated with providing care to the seriously ill patients are some of the universally accepted standards for providing quality palliative care (Leff, Carlson, Saliba Ritchie, 2015). This report aims to elaborate the interrelationship between the Interdisciplinary Team Care Model and quality palliative care and services. This topic holds immense importance as quality palliative care is most certainly dependent upon the collaborative efforts of several healthcare professionals and caregivers to produce optimum results. Discussion: Palliative care is a specialised form of medical health care that alleviates the unavoidable symptoms, pain and stress caused due to serious illnesses and the medical intervention being provided to cure the same. By its definition itself it is evident that it emphasizes more upon religious andnursing care compared to a medicinal approach for the treatment of the concerned patient. The fundamental philosophy of palliative care is based on teamwork by drawing heavily from various domains of knowledge, disciplines and skillsets (Crawford Price, 2003). The approach employs various professionals including nurses, doctors, social workers, health practitioners and a number of therapists to identify and address the unique needs of patients. While dealing with palliative care a clear distinction between several accepted teamwork models must be addressed prominently. A multidisciplinary teamwork model engages several professionals in a hierarchical manner, plying their individual roles mostly in isolation to one another, posing certain practical limitation to the approach (Khasraghi et al., 2004). Conversely palliative care utilizes an interdisciplinary approach of teamwork where members of the team contribute as per their expertise and share their knowledge, experiences and work in an interdependent manner for the greater benefits of the patient. This approach provides relative advantages provided by flexible members of the team willingly to adapt to diverse changing needs of the patients. The need for an interdisciplinary team approach in case of palliative care seems obvious due to wide ranging demands such as practical aids, psychological counselling, financial aid and emotional support, apart from regular pharmacological interventions for the physical; symptoms of the disease. To achieve such long term goals for the patients all the involved members of the team must work in a cooperative and systemic way to deliver the optimum level of care (Ruhstaller, Roe, Thrlimann Nicoll, 2006). Creating such a dedicated palliative care team is often a tedious and complex task and requires contribution from each and every stakeholder involved. Often virtual teams may be formed centred around the patient and the carer, involving the general practitioner, the palliative care specialist doctor or nurse, the pharmacist, social workers, psychologists and even a spiritual carer with whom the patient has long term relationships. Street Blackford (2001), points out that effective com munication is the key factor responsible for smooth functioning of such a virtual team. It has been proven in different domains of science that a team approach or management is beneficial in every aspect compared to simple singular approaches. Similarly in the field of health science multidisciplinary approaches have been adopted widely worldwide; more so in case of palliative care approaches. Palliative care requires a holistic approach towards the patient considering the specialised demands of the serious or even terminal health conditions. Moreover, patients are mostly involved in decision making to impart a sense of being within the patient (Fleissig, Jenkins, Catt Fallowfield, 2006). The team approach contributes immensely to improve the overall quality of life and extends the survival of the patient on a whole. This approach can be applied starting from the very diagnosis of the condition till the very end of treatment. Often the process of diagnosis gets delayed due to the need of seeing various specialists at different diagnostic centres. The treatment procedures get hugely held up due to the relatively longer amount of time taken for completion of the diagnostic tests. A multidisciplinary team of specialist can alleviate such delays by acting and communicating efficiently to diagnose the disease in least possible time. Complete pathological and diagnostic testing can be done in a single centre to make the process hassle-free for the patients. Multidisciplinary case conferencing often includes discussion of treatment opportunities, providing forum for education of health professionals, contributing towards quality improvements, contribute to patient management protocols and contribute to timely referrals and consultation to optimize the level of quality palliative care. Several levels of patient benefits have been reported on performing such case conferencing. Improved survival, increased satisfac tion and greater likelihood of receiving standardized care are some of the patient benefits obtained from such approach. Improved communication between the patients and the caregivers or concerned professionals is one of the prime focuses of palliative care. Studies show that poor communication often leads to psychosocial impacts, anxiety and stress to the patient (Fleissig, Jenkins, Catt Fallowfield, 2006). Such situation can be avoided by consultation with the various involved professionals of the care team. This can ensure understanding of the condition by the patient, decision making, psychosocial and spiritual support, and coordination between providers. Moreover, letting patients participate actively in decision-making responsibilities has been shown to improve satisfaction and boost morale of the patient. However, with benefits comes an array of challenges with the implementation of multidisciplinary approach. According to Rosen Callaly (2005), an efficient team requires clear structure and accountability, good leadership, delegation of tasks, role delineation and mechanisms to resolve role conflicts. There is a misconceived notion that doctors are primarily accountable for the overall health of a patient. But it has been recognised that each and every team member is responsible for their own work and accountable for the quality of care provided in a multidisciplinary scenario. Potent leaders are absolutely necessary in a team who can manage both management tasks i.e. getting the work done efficiently and leadership tasks of engaging and inspiring each member to perform their respective roles efficiently. Improved team performance has been often inked with active leadership skills. Role blurring has been another hurdle in teamwork. Expecting the performance of a common set of tasks b y all the members irrespective of their expertise leads to confusion and mismanagement in many cases. Although a basic level of knowledge and skill is expected from all the care providers, disciplines or individuals must not be indistinguishable from each other, so does their roles in a team (MHPOD., 2017). Setting up forum and arranging multidisciplinary team meeting can be one of the challenge solving methods. It can help improve working relationships, expedite investigation, promote evidence-based treatment and eventually improve clinical outcome. The implementation process can be undertaken in a systemic way by following certain standards. Teambuilding programmes must be undertaken at the earliest stage. There must be a clear and precise idea about the needs of the patient the care is provided for. Organisational and management support must be developed and barriers at these levels must be addressed without delay. Budgets should be developed and managed in a structured manner. A nd most importantly there must be shared sense of interest values among all the members of the team. Decision-making is another very alarming issue in regard to multidisciplinary teams. Democracy, consensus and leadership must be prevalent to ensure that the most appropriate decisions are being made keeping in mind solely the betterment of the patient condition. Clinical supervision should be in place to ensure maintenance of quality standards. Lack of clarity regarding the role and responsibilities often lead to ambiguous accountability issues. Confusions regarding the boundaries of accountability must be eliminated at an early stage. Conclusion A multidisciplinary approach in palliative care has been encouraged extensively due to its long standing benefits and specific patient centred demands for this particular group of patients. With inputs from a diverse array of domains and disciplines this approach can provide the optimum level of quality care for patients with serious terminal diseases and provide overall psychosocial support for the family as well. Several challenges still remain to convert such ideas into practical application. Further studies are required to identify the areas that need to be addressed in order for a multidisciplinary team to work in productive and efficient manner and provide quality care and services for the patients. References Crawford, G. B., Price, S. D. (2003). Team working: palliative care as a model of interdisciplinary practice.Medical Journal of Australia,179(6), S32. Fleissig, A., Jenkins, V., Catt, S., Fallowfield, L. (2006). Multidisciplinary teams in cancer care: are they effective in the UK?.The lancet oncology,7(11), 935-943. Fleissig, A., Jenkins, V., Catt, S., Fallowfield, L. (2006). Multidisciplinary teams in cancer care: are they effective in the UK?.The lancet oncology,7(11), 935-943. Khasraghi, F. A., Christmas, C., Lee, E. J., Mears, S. C., Wenz Sr, J. F. (2004). Effectiveness of a multidisciplinary team approach to hip fracture management.Journal of surgical orthopaedic advances,14(1), 27-31. Leff, B., Carlson, C. M., Saliba, D., Ritchie, C. (2015). 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