An Ethnographic Study of Interprofessional Collaboration in Palliative Care

Background: The concept of the modern palliative care movement was initially developed by Cecily Saunders. She believed that the complex emotional, physical, and spiritual needs of dying patients and their families were best met by a team of professionals working together rather than a sole practitioner. Today local, national, and international definitions of palliative care remain grounded in the philosophy established by Saunders, where care is most effectively delivered by an interprofessional team working in a collaborative manner to support patient and family centred goals. Research Aim: The purpose of this study was to better understand the differences in interprofessional collaboration between palliative care teams in different clinical settings. The research questions were: 1) Do palliative care providers believe interprofessional collaboration is important? and 2) What are the contextual factors that act as either facilitators or barriers to the implementation of interprofessional collaboration in practice? Methods: A qualitative ethnographic methodology was used to understand the factors impacting interprofessional collaboration in three separate teams providing palliative care in different settings in a city in Western Canada. Data were collected and analyzed using Carspecken’s five step process for ethnographic research. Participant observation and focus groups were conducted with interprofessional team members responsible for providing direct care for palliative care patients/families. Findings: Five themes emerged from the data: Interprofessional Collaboration: A Central Tenet of Palliative Care; Interprofessional Communication: The Single Most Important Ingredient for Effective Interprofessional Collaboration; Professional Hierarchy Impacts Interprofessional Collaboration; Role Understanding and Valuing Others; and Facilitators and Barriers to Team Function. Discussion: Findings from this study can be used to better understand how individual, professional, and organizational culture impacts teamwork in the delivery of palliative care and supports opportunities for understanding and mitigating the barriers to interprofessional collaboration in palliative care settings. The structure and values of the team impact interprofessional collaboration: how communication is enacted; how the hierarchy of the team influences who is viewed as having the ultimate authority over care; and how role understanding and valuing others drives interactions with other members of the team