Barriers to multidisciplinary team approach in end-of-life
decision-making: Insights from an Indian hospital
Abstract
A common perception about Multidisciplinary team (MDT) approach is that
it improves quality of care to hospitalized patients, particularly those
who are dying. However, there is paucity of information on challenges in
implementing such approach in end-of-life care (eolc). The present study
explores barriers to MDT functioning in the context of ‘eolc’. Data
collected through interviews of physicians, nurses and other staff, and
review of case records of deceased patients of a multispecialty hospital
in Kolkata (India) suggest that the MDT approach fails to live up to its
rhetoric. One of the major challenges is professional boundary that is
intrinsic to MDT. Due to this, specialist physicians fail to make
consensus end-of-life decisions by overcoming disciplinary boundaries.
Moreover, holistic caregiving is compromised in the physician-dominant
medical team, where nurses and other non-clinical caregivers feel
marginalized. The hospital environment is also not conducive to
multidisciplinary teamwork. Application of a disease-specific treatment
protocol in ‘eolc’ settings aggravates team coordination. ‘Eolc’
referrals and care transfers becomes very difficult. Dying patients and
their families are specially affected by such discordant care. Based on
the findings, the study suggests that while team approach is imperative
to effective ‘eolc’, there is a need to shift focus from
multidisciplinary to transdisciplinary approach to enhance care
integration and patient-centric care to terminally ill patients.