Barriers to Multidisciplinary Team Approach in End-of-life Decision-making: Insights from an Indian Hospital

Abstract

A common perception about multidisciplinary team (MDT) approach is that it improves the quality of care to hospitalised patients. However, there is paucity of information on the challenges in implementing such an approach in end-of-life care (eolc). Conducted in a multispecialty hospital in Kolkata (India), the present study explores barriers to MDT functioning in the context of ‘eolc’. The study finds the MDT approach fails to live up to its rhetoric. One of the major challenges is a professional boundary that inevitably arises in MDTs. Due to this, specialist physicians fail to overcome disciplinary boundaries to make consensus end-of-life decisions. Moreover, in the physician-dominant medical team, where nurses and other non-clinical caregivers’ roles are marginalised, holistic caregiving is compromised. The hospital environment is also not conducive to multidisciplinary teamwork. Application of a disease-specific treatment protocol in ‘eolc’ cases jeopardises team coordination, adversely affects ‘eolc’ referrals and disrupts care transfers. Dying patients and their families are especially affected by such discordant care. Based on the findings, the study suggests that while team approach is imperative to effective ‘eolc’, there is a need to shift focus from multidisciplinary to transdisciplinary approach to enhance care integration and patient-centric care to terminally ill patients.