A Grounded Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions
Abstract
:1. Introduction
2. Methods
2.1. Design and Data Collection
2.2. Data Analysis
2.3. Ethical Approval
3. Results
A Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions
- Component 1: The pathways of Interdisciplinary communication and collaboration
- I.
- Reasons for interdisciplinary communication and collaboration
“The primary care physician refers the patient to me [geriatrician], to assess the patient because of a multitude of problems. I run into complications of lung cancer and other comorbidities and start diagnostics and treatments. Simultaneously, the pulmonologist refers to the internists and the gastroenterologist to treat the same complications of lung cancer. Now, we have three people taking the lead on the same issues”
“The reason we sometimes, I think, make decisions with too little foundation, is that we see a high number of patients during short consultations. (…) Too often we assume that others, who refer the patient to us, have assessed whether the surgery is in line with the patient goals and values.”
“It [a multidisciplinary team meeting] gave them [patient and partner] a sense of peace, confidence that we are truly contemplating her problems, that we’re not abandoning them. We were able to confirm together as a care team that we don’t know all the answers yet. (…) She is now willing to wait and see how it goes.”
- II.
- Timing of interdisciplinary communication and collaboration
“It’s like ‘oh, something is wrong’, and now I must consult the internist, or the pulmonologist, or immunologist, or whatever. You notice it by chance because the patient is visiting your outpatient clinic at that time.”
- III.
- Mode of interdisciplinary communication and collaboration
- IV.
- Outcome of interdisciplinary communication and collaboration
“It is essential to involve the primary care physician in the discussion concerning advance care planning, but also to discuss which tasks the primary care physician is responsible for.”
“It can be good for patients to hear the same story from different people. (…) A patient sometimes needs that, especially when there are many factors at play and a lot of pain.”
“She [the patient] has a history of posttraumatic stress disorder and a cognitive disability. What does that mean for her? What do we need to consider? In hindsight these are things I would have liked to know.”
“The most important thing is that we didn’t operate the aneurysm and avoided looking back saying ‘mm, should we have done that…’. In that regard, it’s not too bad, but in terms of burden, hospital visits, diagnostics… those things we could have avoided for him if we approached it in an interdisciplinary way sooner.”
- V.
- Goal of interdisciplinary communication and collaboration
“You should always try to tailor care to comorbidities, psychosocial context, and the goals, values, and priorities of the patient. It doesn’t matter if you’re the only treating physician or if there are many. And then it depends if it is necessary for this specific patient to gather everyone around a table for a discussion or if a more informal way of collaboration suffices. Like oh, I’m seeing this patient, my plan is this and that, does that align with your plan and goals?”
- Component 2: Internalized Rules of HCPs
“Care coordination by a pulmonologist-oncologist is fine, but they should not meddle with heart failure medication. (…) Giving up control like that is not something easily done within my specialty.”
“Of course, there are a few general specializations, such as internists and geriatricians, but that’s about it. All other specialists work solely from the perspective of their specialization and sub-specialization.”
“What makes the system very fragile, is that it is very dependent on who the patient visits first in the hospital. (….) I think that many specialists, they don’t feel inclined to claim a care coordinator role, they don’t feel equipped, or they don’t have time.”
“Once a referral has been made, then, apparently, a general practitioner or a nursing home doctor is also in a difficult situation because of a family who believes ‘grandma should live until 100’ or whatever it may be. And then there’s unrest, and they come to us, and then you have to proceed.”
“I have two or three neurologists and a few cardiologists specialized in heart rhythm disorders that I can call. And well, among the internist, there are a few that I can approach.”
- Component 3: Organizational structures of influence
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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|
Discipline | Number of Participants in Focus Groups |
---|---|
Internal medicine | 7 |
Geriatrics | 2 |
Cardiology | 2 |
Surgery | 2 |
Orthopedic surgery | 1 |
Rehabilitation medicine | 1 |
Psychiatry | 1 |
Anesthesiology | 1 |
Neurology | 1 |
Psychology | 1 |
Dentistry | 1 |
Nursing home elderly care | 1 |
Gender (male (n); female (n)) | 3 male; 4 female |
Age in years (mean, range) | 69 (55–80) |
Number of chronic illnesses (mean, range) | 4 (3–7) |
Number of health care professionals involved in the outpatient care team (mean, range) | 5 (3–9) |
Emergency department visits in the past year (median, IQR) | 1 (0–3) |
Hospitalizations in the past year (median, IQR) | 2 (0–3) |
Outpatient visits or phone calls in the past year (median, IQR) | 38 (6–57) |
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Gans, E.A.; de Ruijter, U.W.; van der Heide, A.; van der Meijden, S.A.; van den Bos, F.; van Munster, B.C.; de Groot, J.F. A Grounded Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions. J. Pers. Med. 2024, 14, 533. https://doi.org/10.3390/jpm14050533
Gans EA, de Ruijter UW, van der Heide A, van der Meijden SA, van den Bos F, van Munster BC, de Groot JF. A Grounded Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions. Journal of Personalized Medicine. 2024; 14(5):533. https://doi.org/10.3390/jpm14050533
Chicago/Turabian StyleGans, Emma A., Ursula W. de Ruijter, Agnes van der Heide, Suzanne A. van der Meijden, Frederiek van den Bos, Barbara C. van Munster, and Janke F. de Groot. 2024. "A Grounded Theory of Interdisciplinary Communication and Collaboration in the Outpatient Setting of the Hospital for Patients with Multiple Long-Term Conditions" Journal of Personalized Medicine 14, no. 5: 533. https://doi.org/10.3390/jpm14050533