Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study

By conducting constructivist research [22, 23], we were able to develop an understanding of the perceived facilitators of and barriers to IPC according to patients, informal caregivers, and healthcare professionals in general and during MDTMs. Both focus groups and individual interviews were used in this qualitative study to make use of the strengths of each method to enhance the understanding of IPC in LTC and GR perceived by all stakeholders [23, 24]. Interviews provide the opportunity to explore subjects in more detail, centred around the unique experience of a participant that can offer comprehensive perceptions [23, 25]. Whereas focus groups reveal how participants respond to group dynamics that may influence their thinking and behaviour. Focus groups also enable participants with similar backgrounds to use their values and norms [23, 25]. The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ) was used for reporting [26].

The Medical Research Ethics Committee Leiden Den Haag Delft (METC LDD) [N22.027] judged the study to be exempt from the Medical Research Involving Human Subjects Act. Participants received a 20-Euro gift card for their participation. Data were collected between March and December 2022.

Table of Contents

Setting

This study was conducted in Dutch nursing homes that provided LTC and GR care to older people with complex diseases and disabilities [27,28,29,30]. Patients residing in nursing homes are permanently or temporarily unable to live at home and receive 24/7 care. Patient care is provided by a multidisciplinary team consisting of elderly care physicians, psychologists, speech therapists, occupational therapists, physiotherapists, nurses, healthcare aides, spiritual counsellors, social workers, and activity supervisors. Healthcare teams in Dutch nursing homes are led by elderly care physicians, who work closely together with all other healthcare professionals [28]. GR facilities specifically focus on frail elderly people who have complex multimorbidity and reduced learnability and trainability. Generally, GR patients have a reasonable chance of returning to their homes [2]. A multidisciplinary team specialising in GR delivers treatment and care with a higher intensity than the treatment and care provided in LTC [29]. The length of stay in GR is up to six months, but mostly shorter, after which patients can again participate in society [31].

Participants

First, the scientific research committees of the nursing homes were asked whether the organisation wanted to participate in the study. An information package about the study was sent to chair of the scientific research committee, and an additional appointment with the researcher (AD) was scheduled if needed to explain more about the study. After receiving permission, potential participants were approached by the manager. They received an information letter and informed consent form. After agreement to enrol in the study, purposive sampling [23] was used to ensure the minimal number of participants per group for the focus groups and interviews (see ‘Data analysis’ for more details about the sample size). All participants had to work, reside, or have a relative residing in LTC or GR, and have sufficient knowledge of the Dutch language to participate in a focus group or interview. Additional inclusion criteria for healthcare workers were a minimum age of 18 and working in LTC or GR for longer than three months. Informal caregivers had to be actively involved in their relative’s care.

Data collection

When the appointment for the interview or focus group was confirmed, participants received the definition of IPC by the World Health Organisation. Also, they received a link to a short online questionnaire about their demographic characteristics. The questionnaire was made and sent via Castor Electronic Data Capture (Amsterdam, Netherlands), an electronic data capture system that helps streamline the process of collecting, storing, and securing data. A paper version was provided for patients and for participants unable to fill in the questionnaire online. If needed, the researcher provided help with filling in the questionnaire.

Focus groups

Each focus group consisted of at least four participants to enable discussion of the emerging issues [23, 25]. To reduce the possibility of hierarchical influences, we chose to work with separate groups according to the positions in Dutch LTC and GR facilities [28]. Separate focus groups were held for: (1) physicians and therapists; (2) nurses and healthcare aides; (3) managers; (4) patients; and (5) informal caregivers. Participants in a single focus group were all working in the same organisation, however, they could work in different departments or locations.

Focus groups lasted 90 to 120 min and were conducted at the participating organizations. One researcher (AD; male, background in physiotherapy, experience with qualitative research) led the focus groups, assisted by a second researcher (HS; female psychologist with ample experience with qualitative research, or one of the three research interns with a background in medicine or psychology: TV, LS, MD). The second researcher also made field notes.

Researchers used elicitation techniques to facilitate the group discussions and encourage participants to share their ideas [25, 32]. The focus group started with participants being invited to write down facilitators of and barriers to IPC that they experienced. Next, the factors were discussed within the group. The second researcher collected the individual sheets and added those to the transcript of the focus group. Using an inversion technique, participants were then invited to think of hurdles in order to obstruct a MDTM. Following, they were asked how to revolve and solve the hurdles together with the group. The focus group ended with discussing two statements within the group: (1) The use of patient outcome measures during MDTMs enables communication between healthcare professionals, patients, and informal caregivers; and (2) Using patient outcome measures facilitates care.

Semi-structured interviews

Semi-structured interviews lasted 45 to 60 min and were conducted with participants represented in each of the five groups. Four researchers (AD, TV, LS, and MD) conducted live or online interviews, depending on the participant’s preference. The research interns received elaborate instructions on how to conduct the interviews. The interview topic guide is presented in Supplement 1.

Focus groups and semi-structured interviews were conducted simultaneously. Both the focus groups and semi-structured interviews were audio-recorded and transcribed verbatim. We started coding the focus groups and interviews during data collection to ensure data saturation was reached. The transcript or summary of the focus group or interview was not returned to the participants for a member check. This was partly due to practical reasons (e.g., some participants did not have access to an Internet connection, or due to time constraints). Field notes were made during the focus groups and interviews.

Data analysis

A sample size of at least 40 participants for ten focus groups (two per group) was deemed sufficient to generate a general idea of the factors perceived by the stakeholders as influencing IPC in LTC and GR [23, 33]. For the semi-structured interviews, a sample of 10–20 interviews corresponding the five groups was deemed sufficient to reach data saturation [23].

Data were coded by combining an inductive and deductive approach to a thematic analysis [23, 34, 35]. The coding was performed by a team of four researchers (AD, TV, LS, and MD). Two researchers independently coded the transcripts, followed by a consensus meeting. A third researcher was consulted in case the two researchers could not reach an agreement.

The development of the initial coding tree was based on the themes from a review of IPC in LTC and GR [4]. These themes were: (A) team performance, which involves clarity of roles and goals, attitude and interaction between participants; (B) organisational conditions, which included procedures, resources, and leadership; and (C) information sharing, which consisted of communication between and involvement of participants and the exchange of information. Additional codes were added to the coding tree based on inductive coding. Herewith, we generated data-driven codes in addition to theory-driven codes [34].

The six phases of Braun and Clarke for a thematic analysis were followed [34, 36]. During an iterative process, the researchers (AD and HS) searched for relations in codes to develop candidate themes and sub-themes. These themes were discussed between the researchers and the research team to develop an interpretative story. Atlas.ti version 22 facilitated the ordering and structuring of the data [37]. The demographic data of participants was descriptively analysed using SPSS version 25.

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