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The role of the keyworker in breaking down professional culture barriers to providing high-quality palliative care: a literature review

Published online by Cambridge University Press:  04 September 2013

Carina Feuz
Carina Feuz*
Affiliation:
Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
*
Correspondence to: Carina Feuz, 610 University Avenue Rm 6-103, Toronto, Ontario, Canada M5G 2M9. Tel: 416-946-4501 × 3197. Fax: 416-946-2019. E-mail: carina.feuz@rmp.uhn.on.ca
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Abstract

Background

Palliative cancer care is by definition multi-professional in nature. An interdisciplinary approach to disease management emphasising continuity of care results in increased quality of life for patients and families. Complex disease management demands the provision of a full spectrum of high-quality care; requiring both specialist and generalist services. Appointed keyworkers are knowledgeable about patient preferences enabling effective coordination of care and promotes collaborative team-working. The need for diversity in the provision of palliative care is recommended but can challenge effective interdisciplinary collaboration by creating tension and limiting the interdisciplinary team (IDT) from reaching its full potential resulting in adverse outcomes.

Purpose

The purpose of this paper is to review the literature available regarding how IDTs and keyworkers influence high-quality palliative care; evaluate how professional culture barriers can influence team collaboration; discuss the keyworker role in minimising these barriers and clinical implications.

Methodology

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

Results and conclusion

Keyworkers can help overcome professional culture barriers that result from ineffective team communication. Facilitating improved communication regarding professional roles fosters mutual understanding among team members. The dissemination of relevant and timely information minimises fragmentation, prompting team decision-making and promotes continuity of high-quality palliative care.

Keywords

advanced practicecancerinterdisciplinarykeyworkerpalliative careprofessional cultureradiotherapy
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 4 , December 2014 , pp. 465 - 472
Copyright
Copyright © Cambridge University Press 2013 

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References

1. World Health Organization. WHO Definition of Palliative Care. 2013. http://www.who.int/cancer/palliative/definition/en/. Accessed on 26th April 2013.Google Scholar
2. Wittenberg-Lyles, EM, Oliver, DP. The power of interdisciplinary collaboration in hospice. Prog Palliat Care 2007; 15 (1): 6–12.CrossRefGoogle Scholar
3. Wittenberg-Lyles, EM, Oliver, DP, Demiris, G, Regehr, K. Interdisciplinary collaboration in hospice team meetings. J Interprof Care 2010; 24 (3): 264–273.CrossRefGoogle ScholarPubMed
4. National Institute for Clinical Excellence. Improving supportive and palliative care for adults with cancer. 2004. http://www.nice.org.uk/csgsp. Accessed 21st April 2013.Google Scholar
5. Department of Health. NHS End-of-Life-Care Strategy: promoting high quality care for all adults at the end of life. 2008. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/136431/End_of_life_strategy.pdf. Accessed 21st April 2013.Google Scholar
6. Cancer Care Ontario. Improving the quality of palliative care services for cancer patients in Ontario. 2006. https://www.cancercare.on.ca/ocs/clinicalprogs/pallcareprog/. Accessed 21st April 2013. .Google Scholar
7. Abbott, D, Townsley, R, Watson, D. Multi-agency working in services for disabled children: what impact does it have on professionals. Health Soc Care Community 2005; 13 (2): 155–163.CrossRefGoogle ScholarPubMed
8. Hall, P. Interprofessional teamwork: professional cultures as barriers. J Interprof Care 2005; 19 (suppl 1): 188–196.CrossRefGoogle ScholarPubMed
9. World Health Organization. Team Buiding. 2007. www.who.int/cancer/modules/Team%20building.pdf. Accessed 28th April 2013.Google Scholar
10. Pecukonis, E, Doyle, O, Bliss, DL. Reducing barriers to interprofessional training: promoting interprofessional cultural competence. J Interprof Care 2008; 22 (4): 417–428.CrossRefGoogle ScholarPubMed
11. Youngwerth, J, Twaddle, M. Cultures of interdisciplinary teams: how to foster good dynamics. J Palliat Med 2011; 14 (5): 650–654.CrossRefGoogle ScholarPubMed
12. Canadian Hospice Palliative Care Association. The Pan-canadian Gold Standards for Palliative Home Care. 2006. http://www.chpca.net/media/7652/Gold_Standards_Palliative_Home_Care.pdf. Accessed 21st April 2013.Google Scholar
13. Verhovsek, EL, Byington, RL, Deshkulkarni, SQ. Perceptions of interprofessional communication: impact on patient care, occupational stress, and job satisfaction. Internet J Radiolo 2010; 12 (2): DOI: 10.5580/74c. Accessed 29th April 2013.Google Scholar
14. Bainbridge, D, Brazil, K, Krueger, P, Ploeg, J, Taniguchi, A. A proprosed systems approach to the evaluation of integrated palliative care. BMC Palliat Care 2010; 9 (8): http://www.biomedcentral.com/1472-684X/9/8. Accessed 29th April 2013.CrossRefGoogle Scholar
15. Brogaard, T, Jensen, AB, Sokolowski, I, Olesen, F, Neergaard, MA. Who is the key worker in palliative home care? Scand J Caring Sci 2011; 29: 150–156.Google ScholarPubMed
16. Chan, WC, Nichols, J. Improving the coordination of palliative care. Inter J Med Med Sci 2011; 2 (11): 1225–1234.Google Scholar
17. Crooks, VA, Castleden, H, Hanlon, N, Schuurman, N. “Heated political dynamics exist?”: examining the politics of palliative care in rural British Columbia, Canada. Palliat Med 2011; 24 (1): 26–35.CrossRefGoogle Scholar
18. Beales, J, Walji, R, Papoushek, C, Austin, Z. Exploring professional culture in the context of family health team interprofessional collaboration. Health Interprof Prac 2011; 1 (1): eP1004.Google Scholar
19. MacDonald, MB, Bally, JM, Ferguson, M, Murray, BL, Fowler-Kerry, SE, Anonson, JMS. Knowledge of the professional role of others: a key interprofessional competency. Nurse Educ Pract 2010; 10: 238–242.CrossRefGoogle ScholarPubMed
20. Nugus, P, Greenfield, D, Travaglia, J, Westbrook, J, Braithwaite, J. How and where clinicians exercise power: interprofessional relations in health care. Soc Sci Med 2010; 71: 898–909.CrossRefGoogle ScholarPubMed
21. Vyt, A. Interprofessional and transdisciplinary teamwork in health care. Diabetes/Metab Res Rev 2008; 24 (suppl 1): S106–S109.CrossRefGoogle ScholarPubMed
22. Gagliardi, AR, Dobrow, MJ, Wright, FC. How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management. Surg Oncol 2011; 20: 146–154.CrossRefGoogle Scholar
23. Pollock, K, Wilson, E, Porock, D, Cox, K. Evaluating the impact of a cancer supportive care project in the community: patient and professional configurations of need. Health Soc Care Community 2007; 15 (6): 520–529.CrossRefGoogle ScholarPubMed
24. Payne, S, Kerr, C, Hawker, S, Hardey, M, Powell, J. The communication of information about older people between health and social care practitioners. Age Ageing 2002; 31: 107–117.CrossRefGoogle ScholarPubMed
25. Lamb, BW, Taylor, C, Lamb, JN et al. Facilitators and barriers to teamworking and patient centeredness in multidisciplinary cancer teams: findings of a national study. Ann Surg Oncol 2012; 20 (5): 1408–1416.CrossRefGoogle ScholarPubMed
26. NHS Merseyside and Cheshire Cancer Network. Key Worker Guidelines. 2011. http://www.mccn.nhs.uk/fileuploads/File/MCCN%20KEY%20WORKER%20GUIDELINE%20V2%20-%20Reviewed%20November%202011%20(Final)(1).pdf. Accessed 21st April 2013.Google Scholar
27. Herbert, CP. Changing the culture: interprofessional education for collaborative patient-centred practice in Canada. J Interprof Care 2005; 19 (suppl 1): 1–4.CrossRefGoogle ScholarPubMed
28. Ryder, M, Beattie, JM, O'Hanlon, R, McDonald, K. Multidisciplinary heart failure management and end of life care. Curr Opin Support Palliat Care 2011; 5: 317–321.CrossRefGoogle ScholarPubMed
29. Salhani, D, Coulter, I. The politics of interprofessional working and the struggle for professional autonomy in nursing. Soc Sci Med 2009; 68: 1221–1228.CrossRefGoogle ScholarPubMed
30. Fennell, ML, Das, IP, Clauser, S, Petrelli, N, Salner, A. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality. J Natl Cancer Inst Monogr 2010; 40: 72–80.CrossRefGoogle Scholar
31. Mitchell, G, Burridge, LH, Colquist, SP, Love, A. General practitioners’ perceptions of their role in cancer care and factors which influence this role. Health Soc Care Community 2012; 20 (6): 607–616.CrossRefGoogle ScholarPubMed
32. Axelsson, SB, Axelsson, R. From territoriality to altruism in interprofessional collaboration and leadership. J Interprof Care 2009; 23 (4): 320–330.CrossRefGoogle ScholarPubMed
33. Manca, DP, Breault, L, Wishart, P. A tale of two cultures: specialists and generalists sharing the load. Can Fam Physician 2011; 57: 576–584.Google ScholarPubMed
34. Badger, F, Plumridge, G, Hewison, A, Shaw, KL, Thomas, K, Clifford, C. An evaluation of the impact of the Gold Standards Framework collaboration in end-of-life care in nursing home: a qualititative and quantitative evaluation. Int J Nurs Stud 2012; 49: 586–595.CrossRefGoogle Scholar
35. Groot, MM, Vernooij-Dassen, MJFJ, Crul, BJP, FGrol, RPTM. General practitioners (GPs) and palliative care: percieved tasks and barriers in daily practice. Palliat Med 2005; 19: 111–118.CrossRefGoogle Scholar
36. Suter, E, Arndt, J, Arthur, N, Parboosingh, J, Taylor, E, Deutschlander, S. Role understanding and effective communication as core competencies for collaborative practice. J Interprof Care 2009; 23 (1): 41–51.CrossRefGoogle ScholarPubMed
37. Pype, P, Symons, L, Wens, J et al. healthcare professionals’ perceptions toward interprofessional collaboration in palliative home care: a view from Belgium. J Int Care 2012; 27 (4): 313–319. doi: 10.3109/13561820.2012.745488. Accessed 29th April 2013.Google ScholarPubMed
38. Baxter, SK, Brumfitt, SM. Professional differences in interprofessional working. J Interprof Care 2008; 22 (3): 239–251.CrossRefGoogle ScholarPubMed
39. Liston, BW, Wagner, J, Miller, J. A curricular innovation to promote interprofessional collaboration. J Curri Teaching 2013; 2 (1): 68–73.Google Scholar
40. Chung, CLR, Manga, J, McGregor, M, Michailidis, C, Stavros, D, Woodhouse, LJ. Interprofessional collaboration and turf wars: how prevalent are hidden attitudes? J Chiropr Educ 2012; 26 (1): 32–39.Google ScholarPubMed
41. Powell, AE, Davies, HTO. The struggle to improve patient carein the face of professional boundaries. Soc Sci Med 2012; 75: 807–814.CrossRefGoogle Scholar
42. Neergaard, MA, Olesen, F, Jensen, AB, Sondergaard, J. Shared care in basic level palliative home care: organizational and interpersonal challenges. J Palliat Med 2010; 13 (9): 1071–1077.CrossRefGoogle ScholarPubMed
43. King, N, Thomas, K, Martin, N, Bell, D, Farrell, S. “Now nobody falls through the net”: practitioners’ perspectives on the Gold Standards Framework for community palliative care. Palliat Med 2005; 19: 619–627.CrossRefGoogle ScholarPubMed
44. Payne, M. Communication in the palliative care team. Nurs Public Health 2012; 2 (1): 39–48.Google Scholar
45. Spruyt, O. Team networking in palliative care. Indian J Palliat Care 2011; 17 (suppl): S17–S19.CrossRefGoogle ScholarPubMed
46. Petri, L. Concept analysis of interdiciplinary collaboration. Nurs Forum 2010; 45 (2): 73–82.CrossRefGoogle Scholar
47. Zwarenbstein, M, Goldman, J, Reeves, S. Interprofessional collaboration: effects of practice-based interventions on prefoessional practice and health care outcomes (review). Cochrane Database Syst Rev 2009; (3) CD000072.CrossRefGoogle Scholar
48. National Gold Standards Framework Centre. Gold Standards Framework. 2012. www.goldstandardsframework.org.uk. Accessed 28th April 2013.Google Scholar
49. Government of Ontario. Guide to Interdisciplinary Team Roles and Responsibilities. 2005. http://www.health.gov.on.ca/en/pro/programs/fht/docs/fht_inter_team.pdf. Accessed 21st April 2013.Google Scholar
50. Sisler, J, McCormack-Speak, P. Bridging the gap between primary care and the cancer system. Can Fam Physician 2009; 55: 273–278.Google Scholar
51. NHS Greater Midlands Cancer Network. The Key worker Role within Cancer and Palliative Care Services for Adults with Cancer. 2011. http://www.greatermidlandscancernetwork.nhs.uk/uploads/key_worker_policy543bdc3a.pdf. Accessed 21st April 2013.Google Scholar
52. Halkett, GKB, Kristjanson, LJ. Patients’ perspectives on the role of radiation therapists. Patient Educ Couns 2007; 69: 76–83.CrossRefGoogle ScholarPubMed
53. Halkett, GKB, Merchant, S, Jiwa, M et al. Effective communication and information provision in radiotherapy – the role of radiation therapists. J Radiother Pract 2010; 9 (1): 3–16.CrossRefGoogle Scholar
54. Shi, J, Cox, J, Atyeo, J, Loh, Y, Chuong, WL, Back, M. Clinician and therapist perceptions on radiation therapist-led treatment reviews in radiation oncology practice. Radiother Oncol 2009; 89: 361–367.CrossRefGoogle Scholar