Background: In 2017, Saint Luke’s Hospital Koontz Center for Advanced Breast Cancer in Kansas City, MO, began hosting biannual weekend therapeutic retreats for women with metastatic breast cancer and their spouses or caretakers. The 3-day events, based on Lillie Shockney’s A Journey of Courage and Hope retreat protocol, are facilitated by multidisciplinary team members from social work, nursing, psychology, and chaplaincy. Providing effective support to retreat participants required developing effective and flexible models of training and collaboration. This quality improvement project employed qualitative research inquiry to understand the challenges of multidisciplinary teamwork in a therapeutic retreat setting. Results informed the creation of a cross-discipline retreat training program for oncology care providers.
Method: Five oncology care providers from the domains of nurse navigation, psychology, social work, and chaplaincy participated in a semistructured interview about their first experiences working with a multidisciplinary team. Interview responses were transcribed and sent to each provider for editing, amendment, or clarification. The interview data were then deidentified and consolidated. A hermeneutic qualitative data analysis was performed, and thematic clustering findings were reported in a quality-improvement plan format. The team collaborated to design and implement a 3-phase training program to prepare and support multidisciplinary oncology care providers in facilitating these retreats.
Results: Data analysis of the individual interviews resulted in 3 main thematic categories in relation to participating in a multidisciplinary team: Uncertainty About Role Boundaries, Concern About Communication Etiquette (with patients and colleagues), and Desire for Oncology-Specific Psychosocial Training. The group used the results to develop a 3-phase training plan to prepare and support multidisciplinary retreat facilitators:
- Phase I: Preretreat Training
Team members from psychology guided an experiential training on the basic skills for facilitating group discussion of sensitive topics such as death and dying. Training included how to enhance and support emotional awareness within group dynamics; how to delegate leadership roles for multistaff groups; and how to handle challenging situations such as outbursts, withdrawal, or conflict. The group also received an overview of psychosocial research related to supporting death and dying with metastatic populations. - Phase II: Staff Meetings During the Retreat
Regular meeting times were scheduled during meals and in the evening for each retreat day. The meeting agenda included reviewing distress levels for participants, reviewing group discussion skills, and providing an opportunity for staff to reflect and offer or receive support. - Phase III: Postretreat Lessons Learned Meeting
The retreat team members participated in a structured review of retreat events and personal experiences. Areas of difficulties and successes are identified, and the training plan is updated to correct deficits in preparation and training.
Conclusions: The results from this quality improvement qualitative study provided a staff-focused framework to complement A Journey of Courage and Hope retreat manual and provide the opportunity to train additional staff for retreat facilitation. The training program has successfully prepared practitioners for multidisciplinary collaboration in providing therapeutic support for the distinct and often difficult challenges of metastatic breast cancer patients and their families.
Sources
- A Journey of Courage and Hope Metastatic Breast Cancer Retreat Planning and Resource Kit. Pfizer Oncology. 2015.
- Shockney L, Olsen S, Paterno M. The forgotten survivor: supporting women with metastatic breast cancer and their spouses. Journal of Oncology Navigation & Survivorship. 2010;2(4):11-16.
