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I applaud Drs Dracup and Bryan-Brown for their vision and leadership in the editorial "Creating a New Tipping Point in Intensive Care" (November 2006: 537–539) and commend Drs McCauley and Irwin for the revolutionary model of care they describe in "Changing the Work Environment in Intensive Care Units to Achieve Patient-Focused Care: The Time Has Come" (November 2006: 541–548). As an oncology social worker in a department of nursing research and education, I believe passionately in the importance of developing transdisciplinary teamwork and fully support the well-articulated premise that a transformation in our model of healthcare delivery is essential if we are to provide quality critical care to our patients and their families.

However, as Drs Dracup and Bryan-Brown note, most professional education is discipline-specific and few professionals have received specific team-building or collaborative skills training. All this despite a growing body of literature that suggests that multidimensional concerns facing those at the end of life are best addressed through intensive collaboration by an integrated team with specialized palliative care skills.¹ Studies also suggest that team functioning is most effective in an environment of trust where there is an appreciation of the unique perspective each professional contributes to the team.

Social workers, psychologists, and spiritual care providers, like the physicians and nurses described by Dracup and Bryan-Brown, are often ill-prepared to adopt the shared-leadership model essential for change. Deficits in the delivery of quality palliative care are numerous, with troubling findings continuing to emerge regarding disparities in the provision of care, substandard pain and symptom management, poor access to care, increasing caregiver burden, high economic costs, and communication deficits across the continuum of care. Families with a loved one facing a medical crisis or serious illness require competent and compassionate care, yet evidence indicates that few healthcare providers are adequately prepared for this critical task.

To address this challenge, my colleagues and I obtained funding from the National Cancer Institute to develop the ACE Project, "Advocating for Clinical Excellence: Transdisciplinary Palliative Care Education." (Visit http://www.cityofhope.org/ACEproject for more information.) If this transdisciplinary education model proves effective, there will be a cadre of social workers, psychologists, and spiritual care professionals ready to join Drs Dracup and Bryan-Brown in transforming the environment of healthcare not just in the intensive care unit, but across all patient care settings.

Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C
City of Hope National Medical Center, Duarte, Calif

REFERENCE

1. Lawrie I, Lloyd-Williams M. Training in the interdisciplinary environment. In: Speck P, ed. Teamwork in Palliative Care: Fulfilling or Frustrating? Oxford, England: Oxford University Press; 2006:153–165.

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Otis-Green, S. Search for Related Content PubMed PubMed Citation Articles by Otis-Green, S.