Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study

Abstract

Abstract

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.