(music)

Welcome to core competency domain three

-- interprofessional communication.

The purpose of interprofessional education is to help students learn how to work as part of an
effective interprofessional collaborative health care team.

In 2011, the interprofessional

education collaborative also known as

IPEC released four interrelated

core competency domains

for interprofessional education.

These interprofessional education competencies

were developed to better prepare health

professions students to deliberately work

together to meet the common goal

of delivering high quality,

safe, patient-centered health care.

This video will be addressing the

third competency domain which is to

communicate with patients,

families, communities,
and other health professions,

in a responsive and responsible

manner that supports a team approach

to the maintenance of health

and the treatment of disease.

At the end of this training video,

you'll be asked to answer a short series

of questions about this interprofessional

collaborative practice competency.

These questions will help you monitor

your mastery of the competency presented.

The scenario centers around Ella,

a 78 year old woman

who, in collaboration with

her health care team,

had decided to stop further cancer treatments

and transition solely to palliative

medicine and symptom management control.

Ella has been working with her inter-

professional collaborative team for two years.

Her daughter Karen lives out of town

and is not supportive of the decision.

Her daughter is visiting her

mother for the purposes

of reversing her mother's decision

and resuming chemotherapy.

Let's meet the team members.

In addition to Ella -- our patient

-- and her daughter Karen,

there is Dr. Young, the oncologist

who specialized in breast cancer,

Jose, the oncology clinical nurse

specialist an advanced practice

nurse who works with cancer

patients to manage symptoms...

Andrea, the oncology social

worker with advanced

training in palliative care

and psychosocial oncology,

and Dr. Lee,

the oncology pharmacist with

experience in palliative care.

If you want to know more

about the roles on this

team, watch videos one

and two in this series.

We're going to listen in on

the family conference

and then examine how some of the

sub competencies related to

the interprofessional education

communication competency apply.

Thank you everyone for coming today.

We're here to talk together as a

team about Ella's decision to end

her chemotherapy treatments and focus

solely on supportive and palliative

care at this time.

I know Karen has expressed some

concern about her mother's decision.

Ella, would you like to tell

us more about your decision?

Sure.

Basically,

I've chosen to stop any further

treatment for my cancer.

I've thought long and hard about this,

and I feel that it is the right

thing for me to do.

I'm tired of treatment

and I want to focus on enjoying the

rest of the time that I have left.

I understand your decision Ella.

I just want to remind

you though that there are some newly

novel experimental treatments

including mTOR inhibitors

for your specific disease that show promise

and that you would be a candidate for.

I know we discussed this already, but

are you sure you don't want to give

one of these treatments to try?

MTor? What's that?

What does that mean for my mom?

Does it mean we only have experimental treatments left?

It is an experimental treatment that

could impact her cancer, but it may not

-- which is why it is experimental.

It could also make her feel worse and

that is why it is ultimately your choice,

Ella.

Dr.

Young, could you tell us what mTOR is?

I'm not sure we're all

familiar with that drug.

Of course, I'm sorry. mTOR is

shorthand for a type or class

of drug that can be used for cancer.

Am I right, Dr. Lee? Is there

anything you'd like to add?

Yes that's correct. mTOR is a type

of drug used when treating cancer,

but what we don't know is how it will

impact your mother's type of cancer.

I'm sorry for the confusion

Terry, does that help?

Yes, but it sounds like you're

all talking about giving up.

Mom, why have you stop

fighting so aggressively?

I don't want you to go. We need to

do everything possible right now.

Karen, I don't want to take it.

The side effects are horrible.

It's not how I want to

spend the rest of my time.

Dr. Lee, can you explain to

Karen about the side effects?

While it may slow the rate of your

mother's cancer, it won't cure it.

And it can cause severe side effects

such as loss of appetite, fatigue,

diarrhea or pneumonia.

Karen I think it's important

that you know that

I'm not giving up.

I'm simply coming to terms

with the situation.

It's easy for you to say,

"Let's try something new.

There's a new experimental drug.

Let's keep going.

Let's do everything possible."

But the cancer is an experience I

hope you never have to go through.

I love you so much and you know I love you.

And a part of me will always be

with you. But these treatments -- I

know this team that I have here,

they're going to take care of me.

They're going to abide by my wishes.

And so to answer your question Dr.

Young,

I am sure about this decision.

Thank you for the reminder

of the experimental drugs.

I've thought long and hard and I am

very comfortable with my decision.

Ella and I have also had several

conversations with Jose, the past few weeks,

about palliative care which focuses on

symptom management and quality of life.

We've also talked about experimental

treatments such as mTOR,

and we have all reviewed the pros and

cons of these treatments as a team,

and that includes your mother.

Ella, we are here to support

you in any way that we can and

will come up with a care plan together

that makes the most sense to you.

By having your whole team working

together, we'll be able to come up

with a treatment

plan that fits you.

I have a great YouTube video that can help

you understand what to

expect from palliative care.

I've shared it with your mother

and she's found it very helpful.

If you'd like, I can share

with you later, Karen.

I would like to see it when

we're done here.

Of course.
I can see that you have

a really supportive team

around you, and you're going to receive

good care even if they won't cure you.

But I can also see

how my mom made this decision after

speaking with her health care team

and weighing all the options.

It's hard for me.

I don't like it.

I feel sad and helpless,

but

I'm very glad that you have

such an involved team.

And we'll work on a care plan as a team

and we'll reevaluate it regularly.

We're here to continue to support you,

Ella. Please do not hesitate to let us

know how we are doing and if we

need to do anything different.

We will want to make sure the plan of

care is up to date in the electronic health

record so that there is no confusion,

even if none of us is available.

We will have to schedule routine CBCs

regularly to monitor for immunosuppression.

CBCs?

Immunosuppression...

That sounds serious.

Is something going on that

you haven't told me yet?

No, I'm sorry.

I didn't mean to slip into medical jargon.

A CBC is a routine blood test that we do

to check on your mother's ability

to protect herself from infection.

The medication that we gave her

to destroy the cancer

cells also has a side effect of

destroying white blood cells,

which our bodies make to

protect us from germs.

It's a very common problem that people

who've had Ella's treatment have.

Is there anything else that needs to be

discussed in today's meeting that hasn't been

covered?

No I'm good.

Me too.

I think we're just

about done here.

Ella, Karen, are there any other topics

you would like to discuss at this time?

No, I think that's it. I thank you all.

I feel so at ease knowing that

you're my team and that you will

respect and listen

to my wishes and

for right now that's... that's

the best thing that we can have.

I thank you.

A quick debriefing at the end

of team meetings

is one way to give instructive feedback to

others about their performance on the team

-- one of the sub competencies for

interprofessional communication.

It can also improve teamwork, which is

the last interprofessional collaborative

practice competency.

The use of a debrief illustrates

sub competency -- CC5 -- give

timely, sensitive, instructive

feedback to others about their

performance on the team,

responding respectfully as a team

member to feedback from others.

So what we're going on in our meeting went?

What could he have done differently?

Overall I thought the family

meeting went well.

Nice job, everyone.

I forgot about the patient with my

mention of the drug class. I sometimes

assume that patients know this.

Jose, could you not

apologize after me?

I felt bad already.

You're right, I'm sorry.

I'm not sure why I apologized as well.

I thought maybe I had missed

a meeting where the mTOR

class was discussed previously.

Understandable.

I brought up the question to articulate

what I thought Karen I was wondering about.

I'm glad she spoke up so we could make

sure she wasn't confused or worrying about

that too.

I'll follow up with Karen about some

of the feelings she brought up.

Yeah, I'm glad she spoke up too.

Sometimes I forget that everyone doesn't

think in the acronyms that we use daily.

I can't believe I used the term CBC

and immunosuppression right after

we just finished clarifying what mTOR was.

I really need to be

better about avoiding medical jargon when

patients and families are around.

You know it's an easy mistake to make,

but I'm sure if Karen hadn't spoken up,

someone on the team would have caught

it and clarified what was said.

Yeah I hope so.

I mean just another example

of it takes a village.

Agreed I'm really glad we have a

team in place for places like

Ella. It used to be a lot harder to

get all of the patients' needs met when you thought

you were the only one in

charge of their care.

Thanks Jose, for encouraging

this debriefing.

You know, there are always things

that we can do better as a team.

This is interprofessional competency three.

Communicate with patients,

families, communities,

and other health professions

in a responsive
and responsible manner that supports a

team approach to the maintenance of

health and the treatment of disease.

Let's examine what we saw illustrated

in the family team meeting scenario that applies

to the interprofessional communication competency,

along with its sub competencies.

In our family team meeting, the communication

was with the patient, her family,

and health care team members,

all from different professions.

When we look at the specific interprofessional

communications sub competency,

sub competency one: choose

effective communication

tools and techniques including information

systems and communication technologies

to facilitate discussions and

interactions that enhance team function.

Examples from our scenario about effective

communication tools would include

using the YouTube video for

patient education and updating

the electronic health record.

Both of these are communication tools that use

technology to enhance communication with

the patient and the health care team.

TeamSTEPPS, which stands

for team strategies and

tools to enhance performance

and patient safety,

is a national evidence based teamwork

system to improve communication

and teamwork skills among health care professionals.

One of the communication tools used

from teamSTEPPS that we saw illustrated

in the scenario was a technique

called a check back which used

closed loop communication to ensure

that information conveyed by the sender

was understood by the

receiver as intended.

Essentially, an individual repeats the

sender's message and confirms the message was

correctly received.

In our scenario, the check back was illustrated

by Dr. Young asking the pharmacist

Dr. Lee to confirm his

definition of the drug mTOR.

Dr. Lee repeats the message,

confirming that it was correct.

The Web site for team success will be

available at the end of this video.

Sub competency interprofessional

communication two:

organize and communicate information

with patients, families,

and health care team members in

a form that is understandable,

avoiding discipline specific

terminology when possible.

Our scenario highlighted two

opposite examples where medical

jargon was inadvertently

used -- a common occurrence.

Those examples included using the terms

mTOR, CBC, and immunosuppression.

The sub competency is just

more than terminology though.

It tasks us with finding ways to

make information understandable,

which could take a variety of forms

including using pictures, diagrams, videos,

stories, and analogies.

We also need to be sensitive to

reading and health literacy.

In true family centered care,

families are engaged in the conversation,

not just provided with information.

Even though health care team members often share

a common vocabulary of medical terminology,

team members may use

discipline specific terms,

not even understanding that the terms

are not universally understood.

This competency will require that

team members clarify unfamiliar terms

with each other in order to

promote common understanding.

Different disciplines often have

different terms for the same thing.

Several sub competencies address

important communication skills.

Sub competency three: express one's

knowledge and opinions to team members

involved in patient care with

confidence, clarity, and respect,

working to ensure common understanding of information

and treatment and care decisions.

Sub competency four:

listen actively encourage ideas and

opinions of other team members.

Sub competency six: use respectful

language appropriate for a given

difficult situation,

crucial conversation, or

interprofessional conflict.

This scenario qualifies

as a difficult situation,

and the dialog illustrates the

use of respectful language.

Active listening,

encouraging opinions of others,

and expressing one's opinions.

Some of the examples from the scenario that illustrate

sub competency four -- listen

actively -- and encourage ideas and

opinions of other team members were:

Andrea's active listening

resulting in her responding to

Karen her question about mTOR by

asking another team member's opinion.

Dr. Young asking the pharmacist Dr. Lee

to share his drug expertise on mTOR,

and at the end of the meeting Dr.

Young asked other team members

if anything else needs to be discussed.

Thus encouraging others' opinions.

Respectful language was also used

in discussing the conflict which

Jose had apologized for Dr Young

after she had already apologized.

Dr Young was comfortable in expressing

that she felt it was not helpful

and gave that feedback

to Jose, who agreed.

Competency seven:
recognize how one's own uniqueness,

including experience level, expertise,

culture, power, and

hierarchy within the health

care team contributes to effective

communication, conflict resolution,

and positive interprofessional

working relationships.

This sub competency is best

met through self reflection,

thoughtful consideration of how these variables

impact one's professional communication.

Jose's reflecting on his use of an

unnecessary apology would be one example

of self reflection.

Lastly, sub competency eight:

communicate consistently

the importance of teamwork and patient

centered and community focused care.

A good example from the scenario that

communicated the importance of teamwork

and patient centered care was Dr.

Lee's comment that the whole team

working with the patient and her family

will be able to address the patient's

needs and personalize the

care to fit the patient.

Also during the brief, Dr. Young

shared how she values the

health care team in contributing

to quality patient centered care.

A debrief checklist is available for

use from the team steps website,

and includes questions the team

can address during a debriefing.

The IPE competencies can be accessed

at the website on your screen.

For further information about teamSTEPPS,

that can be found at the

website also on your screen.