Palliative care is now provided in almost all settings where health care is provided, including neonatal units, paediatric services, general practices, acute hospitals, residential and community aged care services, and generalist community services. AIHW Report [1]
By working collaboratively, the multidisciplinary team (MDT), in any healthcare setting, ensures that all aspects of a physical, psychological, social, cultural and spiritual care needs are addressed, leading to improved quality of life and care outcomes at the end of life.[2]
There are many functions of the MDT in palliative care, including:
- Advocating on behalf people and their families, especially regarding goals of care and advance care planning
- Implementing multiple strategies to address the needs of the person and their family
- Adapting team membership in response to changing needs throughout the person’s experience of life-limiting illness.[3]
Effective MDTs in palliative care
Common barriers to implementing a MDT approach in palliative care include:
- Poor interprofessional collaboration due to ill-defined boundaries and lack of understanding of the roles and scope of other team members. This can negatively impact on consensus in decision-making, especially in at end of life
- Culture of medical dominance, which causes marginalisation of other team members. This imbalance can affect team dynamics and compromise holistic care
- Time constraints and workload impacting on ability to attend MDTs and/or quality of collaboration and communication within the team
- Lack of resources within the organisation to support a MDT approach.[4,5]
In summary, teams that address barriers and function effectively to provide quality multidisciplinary palliative care have the following characteristics:
- Supportive leadership
- Effective teamwork
- Role clarity
- Collaborative communication
- Diverse expertise within the team, allowing for a range of therapeutic options.[6]
Members of the MDT
In the Australian health context, the MDT is most often made up of the following members:
- Doctors: general practitioners, palliative care consultants, and specialists such as surgeons, oncologists, and physicians.
- Nurses: specialists in palliative care or other speciality area often support continuity and coordination of care. Nurse practitioners who specialise in palliative care or other areas can be involved in providing care also.
- Allied health professionals: this includes a wide range of practitioners and professionals who support holistic care and help to optimise quality of life.
- Cultural and spiritual advisors: support the provision of culturally-responsive care, especially for Aboriginal and/or Torres Strait Islander families.[2,7]
Thinking Points
- What are some of the challenges that can impact on team effectiveness and functioning?
- What strategies can be used by multidisciplinary team members to ensure:
- Clear definition of tasks and responsibilities
- Recognition of and respect for the contribution of each team member
- Clear communication?
- What additional strategies can be implemented to help a team function effectively?
References
- Australian Institute of Health and Welfare (AIHW). 2024. Palliative care services in Australia
- Therapeutic Guidelines. 2023. Overview of Palliative Care. Melbourne.
- CareSearch. 2021. Multidisciplinary Teams.
- Langley, J. et al (2024) Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study. BMJ Open 14(1): e079234.
- Sengupta, J et al (2024) Barriers to a multidisciplinary team approach in end-of-life decision-making: Insights from an Indian hospital. Journal of Health Management 26(2).
- Fernando, G & Hughes, S (2019) Team approaches in palliative care: a review of the literature, International Journal of Palliative Nursing 25(9).
- Victorian State Government. (2017) Better Health Channel: Who’s who in a palliative care team?