Garcia Raquel, Brown-Johnson Cati, Teuteberg Winifred, Seevaratnam Briththa, Giannitrapani Karleen
Duke School of Medicine, Durham (R.G., K.G.), North Carolina, USA.
Stanford University School of Medicine (C.B-J., W.T., B.S., K.G.), Stanford, California, USA.
J Pain Symptom Manage. 2023 Jun;65(6):521-531. doi: 10.1016/j.jpainsymman.2023.01.024. Epub 2023 Feb 9.
Earlier and more frequent serious illness conversations with patients allow clinical teams to better align care with patients' goals and values. Nonphysician clinicians often have unique perspectives and understanding of patients' wishes and are thus well-positioned to support conversations with seriously ill patients. The Team-based Serious Illness Care Program (SICP) at Stanford aimed to involve all care team members to support and conduct serious illness conversations with patients and their caregivers and families.
We conducted interviews with clinicians to understand how care teams implement team-based approaches to conduct serious illness conversations and navigate resulting team complexity.
We used a rapid qualitative approach to analyze semistructured interviews of clinicians and administrative stakeholders in two team-based SICP implementation groups (i.e., inpatient oncology and hospital medicine) (n = 25). Analysis was informed by frameworks/theory: cross-disciplinary role agreement, team formation and functioning, and organizational theory.
Implementing team-based SICP was feasible. Theme 1 centered on how teams formed and managed to come to an agreement: teams with rapidly changing staffing/responsibilities prioritized communication, whereas teams with consistent staffing/responsibilities primarily relied on protocols. Theme 2 demonstrated that leaders and managers at multiple levels could support implementation. Theme 3 explored strengths and opportunities. Positively, team-based SICP distributed work burden, timed conversations in alignment with patient needs, and added unique value from nonphysician team members. Role ambiguity and conflict were attributed to miscommunication and ethical conflicts.
Team-based serious illness communication is viable and valuable, with a range of successful workflow and leadership approaches.
与患者更早且更频繁地进行关于严重疾病的谈话，能让临床团队更好地使医疗护理与患者的目标和价值观保持一致。非医师临床医生通常对患者的意愿有独特的见解和理解，因此在支持与重症患者的谈话方面具有优势。斯坦福大学的基于团队的重症护理计划（SICP）旨在让所有护理团队成员参与进来，以支持并与患者及其护理人员和家属进行关于严重疾病的谈话。
我们对临床医生进行了访谈，以了解护理团队如何采用基于团队的方法来进行关于严重疾病的谈话，并应对由此产生的团队复杂性。
我们采用快速定性方法，对两个基于团队的SICP实施小组（即住院肿瘤学和医院医学小组）的临床医生和行政利益相关者进行了半结构化访谈（n = 25）。分析以相关框架/理论为依据：跨学科角色协议、团队组建与运作以及组织理论。
实施基于团队的SICP是可行的。主题1围绕团队如何形成并达成共识：人员配备/职责快速变化的团队将沟通放在首位，而人员配备/职责一致的团队主要依赖协议。主题2表明各级领导和管理人员都可以支持实施工作。主题3探讨了优势和机遇。积极的方面是，基于团队的SICP分散了工作负担，根据患者需求安排谈话时间，并增加了非医师团队成员的独特价值。角色模糊和冲突归因于沟通不畅和道德冲突。
基于团队的严重疾病沟通是可行且有价值的，有一系列成功的工作流程和领导方法。
