Extending the team component of the Latimer ethical decision-making model for palliative care

Mary Ellen Purkis¹, Elizabeth Borycki^1,2, Craig Kuziemsky³, Fraser Black⁴, Denise Cloutier-Fisher⁵, Lee Ann Fox⁶, Patricia MacKenzie⁷, Ann Syme^1,8, Coby Tschanz^1,4
1School of Nursing, ²School of Health Information Science, University of Victoria, Victoria, British Columbia; ³Telfer School of Management, University of Ottawa, Ottawa, Ontario; ⁴Victoria Hospice Society, Victoria, British Columbia; ⁵Department of Geography, University of Victoria, Victoria, British Columbia; ⁶Kingston General Hospital, Kingston, Ontario; ⁷School of Social Work, University of Victoria, Victoria, British Columbia; ⁸British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada

Background: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.
Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.
Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were not explicit in Latimer's original model. Teams employed five additional emergent team processes when addressing patient symptoms and suffering while attempting to fulfill patient hopes and plans. Those five team processes included explicating practice norms, leadership, provider assumptions, interdisciplinary teaching, and patient safety.
Conclusion: Although many team processes have been identified by practice models in the literature, there is a need to study the applicability of these models empirically to validate their representation of aspects of team practice.

Keywords: interprofessional team practice, palliative care, ethics, ethnography