The Role of the Interdisciplinary Team in Supporting Decision Making
Importance: Supporting decision making is a key component of specialty palliative care. In practice, support for decision making ranges from traditional advance care planning (ACP) to facilitating “in the moment” deliberation. Along this continuum of decision support, members of the palliative care IDT, including medical providers, nurses, social workers, and spiritual care providers, play key roles. Little is known regarding the role and function of the entire IDT in the process of helping patients make decisions. This lack of knowledge is a critical barrier to scaling the high-quality decision making support provided by specialty palliative care to all patients with serious illness.
Objective: To describe the processes, behaviors, and perspectives of specialty palliative care interdisciplinary team members relating to supporting “in the moment” decision making.
Approach: Using an ethnographic approach, I will directly observe interdisciplinary team discussions and inpatient clinical encounters at a single institution. I will identify and describe decision support processes and identify typologies of interdisciplinary decision support. I will also conduct semi-structured interviews with members of inpatient specialty palliative care interdisciplinary teams at multiple institutions, to understand their role(s) in decision making delivered by their interdisciplinary team, as well as barriers and facilitators to participation in decision making.
Results: When this proposed study has been completed, I expect to have a set of themes identified that describe the ways in which a specialty interdisciplinary palliative care team supports medical decision making, with an adapted model to reflect interdisciplinary decision support processes. In addition, I expect to have a thick description of the perspectives of members of IDTs at multiple institutions and in multiple clinical roles, regarding their roles in supporting decision making.
Meredith A. MacMartin, MD, MS, FAAHPM, is an Assistant
professor of Medicine and the Dartmouth Institute for Health Policy and
Clinical Practice, at Geisel School of Medicine at Dartmouth. She is an
attending physician in the section of palliative care at Dartmouth Hitchcock
Medical Center (DHMC), and serves as the medical director for the Jack Byrne
Center for Palliative & Hospice Care. She received her BS from the College
of William and Mary, and her MD from the Wake Forest University School of
Medicine. She completed internal medicine residency and fellowship in hospice
and palliative medicine at DHMC, and in 2019 she completed an MS in research
methods at Dartmouth. Her research interests are focused on understanding
the mechanism of action of palliative care, with a particular focus on decision
making, and the function and dynamics of the interdisciplinary team.