Importance of quality friendship within palliative care teams

– Dr Betty Mary Abraham and Dr Richa Geo, Kochi

People tend to believe that Palliative Medicine is stress-free, as many of them forget the efforts put forward by a palliative care team in helping the patient and their caregivers during their most vulnerable times. Palliative care teams work with patients and their caregivers right from the time an incurable disease which impacts the life of a patient and their caregiver is diagnosed. The team continues to work with the patient and the caregiver during their worst days by tackling the wide range of any distressing symptoms all the way up to the end of life and beyond (bereavement care).

Witnessing these situations are very distressing even for the most experienced Palliative Medicine physicians. From handling the refractory symptoms to difficult conversations, we get emotionally exhausted when compared to our colleagues from other disciplines. Quality friendship and understanding among the palliative care team members are therefore crucial for providing compassionate and effective care to patients and their caregivers.

As the first batch of Palliative Medicine PGs, both in our institution and our State, we are very much aware of the importance of friendship, trust and understanding that is essential for the team and the department to function effectively. As we do not have any seniors, we are each other’s friends, guides and mentors. From checking-in on each other to providing emotional counselling to sharing duties, we are there for each other. Our larger team works round-the-clock to connect all the threads in this multidisciplinary approach of patient care.

We would like to share one of our difficult cases, which was managed effectively due to the friendship within our team.

Beena (name changed), is an 18 year old school topper NIT aspirant who was diagnosed with rhabdomyosarcoma of the nasal cavity, a couple of months ago, just before her 12th standard board exams. Beena was referred to our Institute from a Multi-speciality hospital with palliative medicine. The diagnosis was conveyed to Beena’s family by the treating oncology team there, however it was only at our Institute that they received care jointly from the palliative medicine team and the oncology team. When we met her, we didn’t know what to do and were stuck and helpless. We were overwhelmed as it was not one person (Beena) but a whole family (her parents and other members) whom we needed to manage over a couple of months. It was our consultant who efficiently put the whole team together and guided us.

As PGs we were so proud in how we were able to control her pain, support her emotionally, counsel her family, and had the oppurtunity to stay beside them during their tough times. While caring for Beena, there were several instances where we needed to difficult conversations with Beena’s family. To help and support us, our friends from the Nursing team and the medical social worker provided us with vital information about the family, while our consultants guided us and empowered us adequately to talk to Beena’s family with clarity and integrity.

During the course of Beena’s treatment, she received the results of her examinations and without a doubt, she had topped the class yet again. We helped Beena attend her school farewell before coming back to us for her next round of chemotherapy.

Over time, we became Beena’s chechi’s (sister) instead of being her ‘ma’am’. She now follows our Consultant’s  fashion advice and dresses well each day. As the chemotherapy shed off most of her hair, our Consultant suggested she style her scarf over her head which she does now. Our friendship with Beena also allowed us to receive special ‘treats’ as we were the only people who got special chocolates when her results were announced. The friendship within our team ensured continuous flow of information which helped us to learn that Beena loved KFC. We helped her visit KFC several times despite the risk of being neutropenic.

So you see, palliative care was not just end of life care but much more, and cannot be delivered without a bond being delivered between the members of the team and also with our patients and their caregivers.

We enlist below a few key elements of our intra team friendship which help us tackle difficult situations and enables us to work effectively as a team:

  1. Trust and Honesty: Trust forms the foundation of any friendship. Within a palliative care team, members should trust and be honest with one another, which allows for open communication and collaboration, leading to better decision-making and patient care.
  2. Mutual Respect and Support: Team members should respect each other’s skills, knowledge, and contributions. They should also support each other emotionally, especially in challenging situations. Showing empathy and understanding one’s colleagues help foster a sense of fellowship and strengthens the team’s ability to provide compassionate care.
  3. Open Communication: Transparent and effective communication is vital in a palliative care team. Sharing information, concerns, and constructive feedback enables team members to work together more efficiently. It also encourages a safe space to ask questions, raise concerns, and discuss ideas to foster a sense of belonging and encourages everyone’s involvement and participation.
  4. Collaboration and Cooperation: Friendships within a palliative care team should promote collaboration and cooperation. Each member brings unique skills and perspectives, and working together enhances the quality of care provided. This partnership helps generate innovative ideas, improves problem-solving, and strengthens the team’s overall effectiveness.
  5. Personal Well-being: Quality friendships within a palliative care team involves supporting each other’s well-being, including recognizing and managing burnout, encouraging work-life balance, and fostering a supportive environment. Showing genuine concern for a colleague’s emotional and mental health enhances team morale and creates a positive work environment.
  6. Celebration of Success: Friendships within the team should be marked by celebrating success together. Recognizing and acknowledging individual and group achievements boosts morale, motivation, and a sense of pride. Celebrating success creates a positive atmosphere and reinforces the importance of collaboration and teamwork.
  7. Continuing Education and Growth: Quality friendship within a palliative care team includes a shared commitment to ongoing learning and professional growth. Encouraging and supporting each other’s professional development ensures team members stay updated with best practices and advancements in the field. This shared pursuit of excellence strengthens the team’s ability to provide high-quality palliative care.

Providing palliative care is a challenging task. It requires much planning, discussions, and solid decision making. A multidisciplinary approach is therefore essential to cover all the domains to ensure a comprehensive understanding of the issues to support the patient and their caregivers as needed.

Without a doubt, quality friendships within palliative care teams therefore create a nurturing and a supportive environment that allows the best care possible to be provisioned for patients and their caregivers. It also promotes effective communication, collaboration, and personal well-being, all of which ultimately leads to better outcomes for everyone involved.

In the spirit of friendship, a very Happy Friendship Day to everyone!

About the Authors:

Dr Betty Mary Abraham is a 1st Year PG resident in Palliative Medicine at Amrita Institute of Medical Sciences, Kochi. She completed her under graduation from Azeeiza Medical College Hospital, Kollam.

Dr Richa Geo is a 1st year PG resident in Palliative Medicine at Amrita Institute of Medical Sciences, Kochi. She joined the program after completing her under graduation from the Sree Narayana Institute of Medical Sciences, Ernakulam.

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