Improving health care professionals' collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project

Much improvement is needed to facilitate patient involvement in medical decision-making related to life-prolonging care. Prior research focuses mainly on the communication in the physician-patient dyad; few studies have identified how other professionals are involved. Using a Research Action design, two rounds of interviews with four interprofessional groups from various clinical settings of a health center in Quebec, Canada were conducted between 2009 and 2010. The 37 participants represented nine professions (nurse, dietitian, occupational therapist, orderly, pastoral worker, physician, physiotherapist, respiratory therapist and social worker). The first round of interviews confirmed that all of these professionals are involved, in various ways, in communicating with patients regarding their goals of care. Based on these results, the research group developed two communications tools (paper forms) to facilitate the documentation of patient care goals. The first form includes a designated area where all professionals can note patients' comments regarding decisions related to life-prolonging care. The second is a prescription form to document in the medical file the patient's goals of care. Both tools were submitted to, and fine-tuned by, the professionals in the second round of interviews. These results confirm that interprofessional collaboration to facilitate patient participation in goals-of-care decisions is both possible and valued.