Multidisciplinary Team Meetings as Care in Practice: an ethnography of hospital and community palliative care in the UK

Borgstrom, Erica; Cohn, Simon; Driessen, Annelieke; Dumble, Katie; Martin, Jonathan and Yardley, Sarah (2020). Multidisciplinary Team Meetings as Care in Practice: an ethnography of hospital and community palliative care in the UK. In: 11th World Research Congress of the European Association for Palliative Care World Research Congress, 14-16 May 2020, Palermo, Italy.

URL: https://eapcresearchcongress2020.eu/

Abstract

Background:
Palliative care often involves the use of Multidisciplinary Team Meetings (MDTs), aimed at improving quality and continuity of care. Key to these meeting is the communication about complex cases; yet within the meetings, specific problems may go unresolved and categorical decisions may not be made. Therefore, what are the MDTs for and what do they do?

Aims:
We take the MDTs of two palliative care teams within the same UK NHS (National Health Service) Trust covering acute and community settings as an ethnographic object, to explore what kind of work is done within them and with what effects. We seek to better understand if and how these meetings and teamwork provide care for patients at the end of life.

Methods:
This paper draws on the analysis of over 60 MDTs, observed as part of a larger ethnographic study about forms of care within palliative care. This research, spanning 17 months since May 2018, consisted of shadowing of staff members, and interviews with staff members and patients. Fieldnotes of the meetings were written up during or after the meeting. Emerging themes were identified through coding and memo-ing the material in NVivo 12, informed by practice theory.

Results:
The primary practice takes the shape of ‘feeling one’s way’ together through: complex cases; individual and the team members’ needs to continue performing under mounting work and resource pressures; anticipations of future demands of measuring the work the team provides. While acknowledged and appreciated by all team members as a central part of their daily work, this MDT work is not readily captured as a visible form of patient care, both from patient and carer perspectives, nor from resource planning measures that determine the staff levels.

Discussion:
We argue that there is a need to appreciate and articulate this work as care for different and shifting set of recipients: the patient, the individual team members, the team process, and the meeting itself.

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