Background A hallmark feature of multidisciplinary team care is patient-centeredness; every aspect of patient's health status is systematically evaluated and the treatment goals and plans for interventions are jointly set, evaluated, attuned.1 But the perceptions and values of patients and health care professionals (HCPs) about the role and degree of active involvement of patients in team care has received little attention.
Objectives To explore patients' and HCPs views on the meaning and role of patient participation in team care, and to explore the experiences of patient membership in team conference.
Methods This study was conducted before and after the introduction of patients in team conference. To explore the views about patient participation semi-structured face-to-face interviews were held with 10 patients with rheumatic diseases eligible for or participating in multidisciplinary treatment and 12 HCPs. After the introduction of patients' membership in the team conference, telephone interviews with 8 patients and a focus group (n=5) with HCPs were held. The interviews and the focus group were audiotaped and described verbatim. Thematic content analysis of the interviews were performed by two researchers independently and discussed until consensus was reached. Similarly, data of the telephone interviews and focus group were analysed and identified topics were discussed by a rheumatology nurse and a researcher.
Results Participants described patient participation in terms of an active participatory behaviour of the patient (e.g. willingness to change, motivation, asking questions, expressing their own opinions, treatment adherence), an open respectful dialogue between patients and HCPs based on trust and equality, and (shared) responsibility of treatment. Participants indicated that patients' involvement in team care varied, from passive receiver to meaningful exchange between patients and HCPs. Opportunities for improvement were identified: improving information about the treatment, facilitating patient involvement in goal-setting, planning and evaluation of treatment, and stimulating patient's responsibility of care. After the introduction of patients in team conference, the evaluation of patient membership revealed that although some patients felt tense the atmosphere felt safe and they experienced a honest, transparent and respectful interaction between themselves and HCPs. Patients felt they were taken seriously and that their needs were taken into account, the treatment goals were set in mutual agreement and the resulting therapeutic interventions were clear and satisfactorily. HCPs valued patient's membership in team conference, although they needed to get used to it. HCPs experienced an open, honest and truthful team dialogue and a truly shared treatment plan leading to more patient commitment to treatment. The limited time, prior to team conference, to formulate a draft treatment plan to be discussed during the team conference, was seen as a disadvantage, especially in complex cases.
Conclusions Patients and HCPs highly valued patient's membership in the multidisciplinary team conference. Treatment plans were developed in partnership between patients and HCPs, and team interaction was based on mutual trust and respect. This study underscores the value of stimulating partnership in team care.
Vliet Vlieland et al. (2006). Does everybody need a team? J Rheumatol 33(9):1897–9.
Disclosure of Interest None declared