Collaborative Practice in Palliative Care

Dave Roberts, Laura Green, Dave Roberts, Laura Green

• Publisher: Taylor & Francis
• Year: 2021
• eBook ISBN: 9781351113458
• Edition: 1
• Topic: Medicine
• Subtopic: Anesthesiology & Pain Management

Collaborative Practice in Palliative Care explores how different professions work collaboratively across professional, institutional, social, and cultural boundaries to enhance palliative care.

Analysing palliative care as an interaction between different professionals, clients, and carers, and the social context or community within which the interaction takes place, it is grounded in up-to-date evidence, includes global aspects of palliative care and cultural diversity as themes running throughout the book, and is replete with examples of good and innovative practice. Drawing on experiences from within traditional specialist palliative care settings like hospices and community palliative care services, as well as more generalist contexts of the general hospital and primary care, this practical text highlights the social or public health model of palliative care. Designed to support active learning, it includes features such as case studies, summaries, and pointers to other learning resources.

This text is an important reference for all professionals engaged in palliative care, particularly those studying for post-qualification programmes in the area.

CHAPTER 1
What is collaborative practice and why is it important in palliative care?

Dave Roberts

DOI: 10.4324/9781351113472-1

Outline

Palliative care is an essentially collaborative activity. Since the earliest development of the hospice movement, care was organised within teams, making the most of each professional contribution to deliver holistic care of the patient. Dame Cecily Saunders, the founder of contemporary palliative care, was herself an outstanding example of interprofessionalism, training first as a nurse, then medical almoner (equivalent to social worker), before finally training as a doctor, the professional base which gave her the opportunity to develop care for the dying according to her vision. As palliative care has evolved, it has continued to function as a collaboration between different professions, and as a collaboration between patient, family, and professional.

Background

As palliative care has moved outside of the hospice base, it has involved collaborations within hospitals, care homes, and primary care, working across professional boundaries and across organisations. This boundary crossing has been characterised as between specialist palliative care staff and generalist care staff, and using a palliative care approach. The following are common definitions of these levels of palliative care work:

• Specialist palliative care is provided by specially trained professionals whose primary area of practice is palliative care, whether this is in a hospice, hospital, or community setting. Palliative care specialists also support and educate generalists and those using the palliative care approach.
• General palliative care is provided by health and social care staff whose work regularly involves aspects of palliative care, and who have good basic palliative care skills and knowledge, but this is not their primary responsibility (for example cancer specialist doctors and nurses).
• Palliative care approach is the application of palliative care aims, methods and procedures in general (non-palliative care) settings, including acute (hospital), primary care (home), and long term care (nursing and residential care homes).

Collaborative practice is essentially professionals working together towards a common purpose, for the benefit of their patients or clients. When teams work together, their efforts as a team are greater than their individual contributions. Increasingly, we also see collaboration as involving the patient and their family. In the palliative care setting, non-professional volunteers are often part of the team. Collaboration has the meaning of an active and ongoing process, involving people from different backgrounds, working together to solve problems and provide services (Reeves et al., 2010).

Palliative care is well defined, and the following definition from the European Association for Palliative Care (EAPC) emphasises its collaborative nature:

Palliative care is the active, total care of patients whose disease is not responsive to curative treatment. Palliative care takes a holistic approach, addressing physical, psychosocial and spiritual care, including the treatment of pain and other symptoms. Palliative care is interdisciplinary in its approach and encompasses the care of the patient and their family and should be available in any location including hospital, hospice and community. Palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death and sets out to preserve the best possible quality of life until death.

(Radbruch et al., 2010, p. 280)

The terms palliative care and end of life care are often used interchangeably. However, end of life care refers to the period of months or years when it is apparent that the patient has a life-limiting illness, or more specifically to the care of dying patients in the last hours or days of life. Recently, the inclusive term Palliative, End of Life and Bereavement care (PEoLB) has also come into use. Within this book, palliative care is used to describe the whole range of palliative care services, unless the discussion is specific to end of life care or bereavement support.

Interprofessional practice

Collaboration in contemporary palliative care can be viewed within the context of interprofessional practice (IPP). Alternative terminology includes interdisciplinary or multidisciplinary, and the latter term is often used in referring to the multidisciplinary team, or MDT. Strictly speaking, multidisciplinary refers to academic disciplines, though in this context it refers to professional specialisations. Multidisciplinary meetings are one of the key ways in which interprofessional teams operate. Whereas interprofessional working is the norm in specialist palliative care, it may not be in other settings where a palliative care approach is used. It is important to be aware of the different ways in which professionals can work together.

There is a range of terminology that can be used to describe different degrees of working together and integration of professional activity:

• Teamwork implies a very close working relationship with a shared sense of team identity.
• Coordination is a looser working relationship.
• Integrated , as in integrated care pathway, describes activities coordinated along a specific illness trajectory.
• Networking is sporadic communication and coordination between groups, when needed.
• Partnership may describe the working relationships between two groups.

Alongside these differences, collaboration has value as an overall term for groups working together for a common purpose. The working relationship may be close or looser depending on the nature of the work and the demands that it makes. As a general rule, the more urgent and unpredictable the demands of the work, the greater the need for close teamwork, and where the demands are more routine and predictable, the more suitable a coordinated or networking relationship becomes.

Factors that underlie collaborative practice include communication and decision making, responsibility, accountability, cooperation, assertiveness, autonomy, mutual trust, and respect (Bridges et al., 2011). Teamwork is effective when there are common goals and a sense of shared identity (see Box 1.1).

Box 1.1 Effective teamwork requirements

For professionals to function effectively as a team they need to have:

• Clear goals (focused on patient/client care).
• Shared team identity.
• Shared commitment.
• Clear team roles and responsibilities.
• Interdependence between team members.
• Integration between work practices.

(Reeves et al., 2010)

Why collaborate?

Traditionally, health care and treatment has been organised according to an acute care model, where discrete conditions were expected to respond to specific interventions leading to a satisfactory outcome. This was associated with a hierarchical structure, often dominated by the medical profession. With the shift to long term conditions, and increasingly complex health and social care management, more diverse teams have become more common, and the emphasis is more on models of collaboration. This offers better opportunities for managing quality and safety, and for better integration of the patient and family into the processes of decision making (Reeves et al., 2010).

There is also evidence that collaborative practices lead to improvements in access to services, better use of specialist services, and a reduction in hospital admissions, length of stay, clinical errors, patient complications, and mortality (WHO 2010). Organisationally, collaboration makes sense as the best way to manage limited resources and maximise the potential input of each member of the interprofessional team.

One of the problems with IPP is that professionals are trained and socialised within their own professional groups, learning the norms and values, alongside professional codes of practice, rules, and regulations. There is therefore the potential for conflict between roles if their professional values or interests are seen to be compromised. This is a particular risk if communication is poor or if roles are not clearly defined, and it can also be exacerbated at times of stress or high demand (Hall 2005).

In addition, professionals may not be taught the range of skills needed to manage complex interprofessional situations. In response to this problem, a number of initiatives have arisen to enable students of different professional groups to learn together: interprofessional education (IPE). This does not replace professional education programmes but enhances them and mirrors the reality of health care practice. It provides opportunities for learning about and with each other, sharing skills and knowledge, and learning to respect each other’s roles and values (Bridges et al., 2011). IPE can continue after professional registration, and can include students, professionals, and academics learning together (WHO 2013). There is an overlap between IPP and IPE, in that the practice of working together provides opportunities to learn, so that IPE can function alongside practice (Reeves et al., 2011).

Collaborative practice in palliative care

Palliative care, with its emphasis on holistic care, is well suited to a collaborative approach. Indeed, the integration of different professionals in the care of the patient and family is both desirable and inevitable. In the words of Radbruch et al.,

Palliative care is supposed to be provided within a multiprofessional and interdisciplinary framework. Although the palliative care approach can be put into practice by a single person from a distinct profession or discipline, the complexity of specialist palliative care can only be met by continuous communication and collaboration between the different professions and disciplines in order to provide physical, psychological, social and spiritual support.

(Radbruch et al., 2010, p. 284)

As palliative care has grown beyond the hospice, and diversified from its earlier focus on cancer, new working relationships have developed, and the distinction between the specialist palliative care practitioner and their generalist colleagues has emerged. These have primarily involved hospital-based colleagues, for example, on oncology wards, and colleagues in primary care. Working across professional boundaries and across different settings is helped by having a sense of common purpose and keeping the interests of the patient and their family at the heart of decision making and care planning.

Effective collaboration is supported by good, clear definition of roles and responsibilities, making the most of opportunities for shared learning and education, good access to specialist palliative care services, and coordinated care (Gardiner et al., 2012). Factors that hinder effective working include the uncertainty of the illness trajectory, often a challenge in non-cancer conditions where the transition to palliative care is less predictable, lack of definition of professional roles, and lack of coordination between prof...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Copyright
• Dedication
• Contents
• List of figures
• List of tables
• List of boxes
• List of contributors
• Foreword
• Acknowledgements
• 1 What is collaborative practice and why is it important in palliative care?
• 2 The importance of place: Collaboration across institutional boundaries
• 3 Seeing a familiar face: Collaboration across professional boundaries
• 4 Caring for the person in their world: Collaboration in context
• 5 Systems within systems: Collaboration with the family
• 6 Building bridges: Collaboration between organisations
• 7 Psychological care: Everybody’s business?
• 8 Compassionate communities: Working with marginalised populations
• 9 Collaboration in palliative care: Global perspectives
• 10 The future: Developing collaborative palliative care
• Index