Clinicians’ Perspectives on Strengthening Interprofessional Teamwork to Support Surrogate Decision-Makers of Critically Ill Patients in ICUs

Abstract

IMPORTANCE: – Professional societies recommend interprofessional collaboration to support ICU surrogate decision-makers, yet little is known about how to operationalize it. OBJECTIVES: – Determine clinicians’ perceived acceptability of interprofessional collaboration to support surrogates of ICU patients facing goals-of-care (GOC) decisions and identify barriers/facilitators to implementing a proposed interprofessional collaboration intervention. DESIGN, SETTING, AND PARTICIPANTS: – Mixed-methods study with ICU clinicians from four hospitals in Pennsylvania and Ohio. Surveys assessed acceptability across three domains: perceived effectiveness, self-efficacy, and attitudes. Clinicians from two ICUs without an interprofessional collaboration program also answered interview questions eliciting barriers/facilitators to implementing a proposed interprofessional collaboration intervention. ANALYSIS: – Descriptive statistics for survey data and content analysis of interview transcripts. RESULTS: – We surveyed 56 clinicians: 25 physicians and advanced practice providers (APPs), and 31 other healthcare professionals (22 nurses, 3 social workers, 6 others), and interviewed 24. Ninety-eight percent agreed that enhanced interprofessional collaboration improves surrogate support. Among other healthcare professionals, 61% wanted a larger role in GOC decisions, 97% felt confident providing emotional support, and more than 74% were confident in reinforcing prognostic information and discussing values/preferences and GOC. ICU physicians/APPs were all comfortable with nurses and social workers providing emotional support, and most were comfortable with nurses (> 80%) and social workers (> 60%) reinforcing prognostic information and discussing values/preferences, and GOC. Although more than 95% of nurses and others were confident discussing physician-proposed treatment options, only 33% of social workers were, and less than or equal to 50% ICU physicians/APPs were comfortable with nurses/social workers doing so. 94% of ICU physicians/APPs supported adopting an interprofessional collaboration intervention with shared mental models, defined roles, and training. Barriers included team turnover, time constraints, evolving care plans, and training feasibility. Facilitators included specialized training, clear roles, and knowledge of the evidence base for interprofessional collaboration. CONCLUSIONS: – Most clinicians across roles found interprofessional collaboration for GOC decisions acceptable, with clear responsibilities, specialized training, workflow fit, and education on its value as key facilitators for implementation.