Waldfogel Julie M, Battle Dena J, Rosen Michael, Knight Louise, Saiki Catherine B, Nesbit Suzanne A, Cooper Rhonda S, Browner Ilene S, Hoofring Laura H, Billing Lynn S, Dy Sydney M
Johns Hopkins University, Baltimore, MD.
J Oncol Pract. 2016 Nov;12(11):1135-1140. doi: 10.1200/JOP.2016.013862. Epub 2016 Oct 31.
End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.
癌症患者的临终决策可能是一个复杂的过程。患者及其家属在整个癌症治疗过程中会接触到多个医疗服务提供者。当这些医疗服务提供者在团队中的努力没有得到很好的协调时，就可能错过进行高质量、长期护理目标讨论的机会。本文回顾了一名55岁肺癌患者的病例，通过团队领导这一团队科学中的关键原则，阐述了其治疗过程中临终决策的障碍和错失的机会。该病例中所展示的挑战反映了团队领导四项职能的重要性：信息搜索与构建、问题解决中的信息利用、人力资源管理以及物质资源管理。参与这四项职能的共享领导有助于医疗服务提供者在临终护理决策方面改善与患者及其家属的互动。这种共享领导还可以制定出一个连贯的护理计划，该计划受益于众多可用医疗服务提供者的专业知识，同时反映患者的需求和偏好。临床医生和研究人员在开发和研究癌症护理模式时，应考虑团队领导职能和共享领导在改善患者护理方面的作用。
