scholarly journals Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer

2016 ◽  
Vol 12 (11) ◽  
pp. 1039-1045 ◽  
Author(s):  
Sarah F. D’Ambruoso ◽  
Anne Coscarelli ◽  
Sara Hurvitz ◽  
Neil Wenger ◽  
David Coniglio ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Palliative Care ◽  
Nurse Practitioner ◽  
Mental Model ◽  
Shared Understanding ◽  
Shared Mental Model ◽  
Team Members ◽  
Close Proximity ◽  
Integrated Team

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team’s close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient’s burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

scholarly journals Predictors of ACP competency among Chaplains by Service Line

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 779-779
Author(s):  
Soyeon Cho ◽  
Jung Kwak ◽  
Brian Hughes ◽  
George Hands ◽  
Moon Lee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Positive Attitude ◽  
Online Survey ◽  
Special Care ◽  
Hierarchical Regression ◽  
Shared Decision ◽  
Team Members ◽  
Significant Difference

Abstract Healthcare chaplains have key roles in palliative care including facilitating advance care planning (ACP). However, little is known about chaplains’ competency in ACP. We conducted an online survey with board-certified healthcare chaplains recruited from three major professional chaplains’ organizations. We explored correlates of chaplains’ competency in ACP facilitation among two groups of chaplains, general and special care (SC) chaplains (chaplains in oncology, intensive care, or palliative units) because SC chaplains are generally more involved in palliative care. The final sample included 481 chaplains with 89.8% reporting ACP as an important part of their work and 71.3% reporting to help patients complete advance directives. There was no significant difference in ACP competency between general chaplain group (n=240; M=39.61, SD=7.0) and SC chaplain group (n=241; M=40.65, SD=5.87). Hierarchical regression analyses revealed differences between the groups. General chaplains who practiced longer as a chaplain (b=1.02, p<.000), were more engaged in ACP facilitation (b=1.06, p<.05), had more positive attitude toward ACP (b=4.04, p<.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p<.000) were more competent in ACP facilitation. In the SC chaplain group, higher competency was associated with more positive attitude towards ACP (b=2.58, p <.05), and a higher level of participation in shared decision-making (b=1.05, p <.000). Overall, these findings suggest that healthcare chaplains, both general and special care, are competent and actively involved in ACP facilitation. Further systematic studies are warranted to examine the effects of chaplains facilitating ACP on patient and healthcare system outcomes.

scholarly journals An Exploratory Qualitative Study of Computer Screening to Support Decision-Making about Use of Palliative Care Registers in Primary Care: GP Think Aloud and Patient and Carer Interviews

2021 ◽  
Vol 12 ◽  
pp. 215013272110244
Author(s):  
Gill Hubbard ◽  
Kirsten Broadfoot ◽  
Clare Carolan ◽  
Hugo C. van Woerden
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Screening Program ◽  
Clinical Decision ◽  
Think Aloud ◽  
Advanced Illness ◽  
Curative Intent ◽  
Sole Criterion

Objectives: This study aimed to understand factors that influence general practitioner (GP) use of automated computer screening to identify patients for the palliative care register (PCR) and the experiences of palliative care and this emerging technology from patients’ and carers’ perspectives. Methods: A computer screening program electronically searches primary care records in routine clinical practice to identify patients with advanced illness who are not already on a PCR. Five GPs were asked to “think aloud” about adding patients identified by computer screening to the PCR. Key informant interviews with 6 patients on the PCR and 4 carers about their experiences of palliative care while on the PCR and their views of this technology. Data were analyzed thematically. Results and Conclusions: Using computer screening, 29% additional patients were added by GPs to the PCR. GP decision-making for the PCR was informed by clinical factors such as: if being treated with curative intent; having stable or unstable disease; end-stage disease, frailty; the likelihood of dying within the next 12 months; and psychosocial factors such as, age, personality, patient preference and social support. Six (60%) patients/carers did not know that they/their relative was on the PCR. From a patient/carer perspective, having a non-curative illness was not in and of itself sufficient reason for being on the PCR; other factors such as, unstable disease and avoiding pain and suffering were equally if not more, important. Patients and carers considered that computer screening should support but not replace, GP decision-making about the PCR. Computer screening merits ongoing development as a tool to aid clinical decision-making around entry to a PCR, but should not be used as a sole criterion. Care need, irrespective of diagnosis, disease trajectory or prognosis, should determine care.

Meeting the challenge of workplace change: Team cooperation outperforms team competition

2019 ◽  
Vol 47 (7) ◽  
pp. 1-15 ◽  
Author(s):  
Chen Yue ◽  
Patrick S.W. Fong ◽  
Teng Li
Keyword(s):  
Mental Model ◽  
Model Updating ◽  
Workplace Change ◽  
Shared Mental Model ◽  
Team Members ◽  
Uncertain Environment ◽  
Team Cooperation ◽  
Team Adaptation ◽  
Training Team ◽  
Competitive Structure

We examined the influence of reward structures on team adaptation. We collected data from Chinese university students, whom we assigned to 62 teams of 3 members. They took part in a team-based card game in a laboratory setting to test if a cooperative structure promotes team adaptation by facilitating shared mental model updating, and if a competitive structure harms team adaptation by preventing shared mental model updating. This proposition was supported by the results of the between-group factorial design experiment: The efficiency of the shared mental model was lost when predicting team performance in an uncertain environment. Teams with a cooperative structure outperformed teams with a competitive structure in the task changes, and this effect was mediated by shared mental model updating. Thus, team managers should adopt a cooperative-based structure in an uncertain environment to achieve team adaptation, as well as training team members to understand the changed situation.

CHANGING OF MENTAL MODELS FOR EFFECTIVE DECISION-MAKING

2018 ◽  
Vol 1 (11) ◽  
pp. 209-228
Author(s):  
Yuriy Vasilievich Naplyokov
Keyword(s):  
Decision Making ◽  
Mental Models ◽  
Decision Maker ◽  
Mental Model ◽  
Additional Energy ◽  
Team Members ◽  
Legislative Proposals ◽  
Additional Energy Expenditure ◽  
Effective Decision Making ◽  
As Stress

This article explains the role of mental models and the need of their change to make effective decisions. It is substantiated that the mental model rests on changes to save the system and minimize the risk. An example of this resis- tance is the complicated and slow process of political reform in Ukraine, which forms a new national mentality model. Political initiatives are aimed at creating a new legitimate mental model, which should be more effective than the previ- ous, in a new environment. But from 2014 to 2017 of the nearly five thousand proposed legislative proposals, the Verkhovna Rada of Ukraine has only adopted a few dozen. It is noted that the review of mental models is a complex process that requires additional energy expenditure, such as stress, loss of comfort, security, money, etc. The ability to change the mental model may require personal courage, creativity, independence, and imagination. To view mental models, the leader must apply the appropriate leadership power and styles, establish an appropriate organizational culture and climate, show positive and optimistic behavior to en- courage team members and motivate them to change.It is noted that in the new environment, the decision maker can fluctuate closely to the so-called “line of comfort” for making a decision. This is a line of psychological comfort according to the existing mental model. For better and faster decision-making, you may need to create a new “line of comfort” by looking at the mental model. Thus, in a new environment, the decision maker can again make decisions on the basis of a new mental model.It is proved that mental models are relatively stable, but changing the envi- ronment makes them look. The growing conflict between the system and the en- vironment inevitably forms a new mental model, which should again balance the system.

CHANGING OF MENTAL MODELS FOR EFFECTIVE DECISION-MAKING

2018 ◽  
Vol 1 (12) ◽  
pp. 209-228
Author(s):  
Yuriy Vasilievich Naplyokov
Keyword(s):  
Decision Making ◽  
Mental Models ◽  
Decision Maker ◽  
Mental Model ◽  
Additional Energy ◽  
Team Members ◽  
Legislative Proposals ◽  
Additional Energy Expenditure ◽  
Effective Decision Making ◽  
As Stress

This article explains the role of mental models and the need of their change to make effective decisions. It is substantiated that the mental model rests on changes to save the system and minimize the risk. An example of this resistance is the complicated and slow process of political reform in Ukraine, which forms a new national mentality model. Political initiatives are aimed at creating a new legitimate mental model, which should be more effective than the previous, in a new environment. But from 2014 to 2017 of the nearly five thousand proposed legislative proposals, the Verkhovna Rada of Ukraine has only adopted a few dozen. It is noted that the review of mental models is a complex process that requires additional energy expenditure, such as stress, loss of comfort, security, money, etc. The ability to change the mental model may require personal courage, creativity, independence, and imagination. To view mental models, the leader must apply the appropriate leadership power and styles, establish an appropriate organizational culture and climate, show positive and optimistic behavior to encourage team members and motivate them to change. It is noted that in the new environment, the decision maker can fluctuate closely to the so-called “line of comfort” for making a decision. This is a line of psychological comfort according to the existing mental model. For better and faster decision-making, you may need to create a new “line of comfort” by looking at the mental model. Thus, in a new environment, the decision maker can again make decisions on the basis of a new mental model. It is proved that mental models are relatively stable, but changing the environment makes them look. The growing conflict between the system and the environment inevitably forms a new mental model, which should again balance the system.

scholarly journals Palliative Chaplain Spiritual Assessment Progress Notes

2020 ◽  
pp. 181-198
Author(s):  
Paul Galchutt ◽  
Judy Connolly
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Focus Groups ◽  
Research Question ◽  
Major Result ◽  
Team Members ◽  
Spiritual Assessment ◽  
Interprofessional Team ◽  
Progress Notes ◽  
And Coping

Abstract Research question “What is helpful as well as missing from palliative chaplain spiritual assessment progress notes?” arose from the context of seeking to know how palliative chaplain spiritual assessment progress notes can best be relevant and make a difference for a patient’s care. Seven focus groups, two of which were in a children’s hospital context, were hosted with 42 non-chaplain palliative team participants. The major results revealed four important considerations for palliative care chaplains. First, palliative interprofessional team members want more help and information regarding a patient’s decision-making, especially related to a patient’s religion and/or spirituality. Second, and in line with palliative care principles, the participants discussed their desire for relevant notation on a patient’s sense of suffering and coping. Third, a request was made for the chaplain to consistently document his/her perception of emotion emerging from the patient and/or family. The last major result to emerge was that the progress notes should have a summary content section at the top of the note with the most important information contained there.

Measuring shared mental models in healthcare

2018 ◽  
Vol 23 (5) ◽  
pp. 207-219 ◽  
Author(s):  
Logan M Gisick ◽  
Kristen L Webster ◽  
Joseph R Keebler ◽  
Elizabeth H Lazzara ◽  
Sarah Fouquet ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Models ◽  
Mental Model ◽  
Quantitative Methods ◽  
Clinical Decision Making ◽  
Measurement Methods ◽  
Shared Mental Models ◽  
Shared Mental Model ◽  
Qualitative And Quantitative ◽  
Model Measurement

Objective To review common qualitative and quantitative methods of measuring shared mental models appropriate for use in the healthcare setting. Background Shared mental models are the overlap of individuals’ set of knowledge and/or assumptions that act as the basis for understanding and decision making between individuals. Within healthcare, shared mental models facilitate effective teamwork and theorized to influence clinical decision making and performance. With the current rapid growth and expansion of healthcare teams, it is critical that we understand and correctly use shared mental model measurement methods assess optimal team performance. Unfortunately, agreement on the proper measurement of shared mental models within healthcare remains diffuse. Method This paper presents methods appropriate to measure shared mental models within healthcare. Results Multiple shared mental model measurement methods are discussed with regard to their utility within this setting, ease of use, and difficulties in deploying within the healthcare operational environment. For rigorous analysis of shared mental models, it is recommended that a combination of qualitative and quantitative analyses be employed. Conclusion There are multitude of shared mental model measurement methods that can be used in the healthcare domain; although there is no perfect solution for every situation. Researchers can utilize this article to determine the best approach for their needs.

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