Better teaming for pain across disciplines

Lack of cross-disciplinary role agreement may result in delays in clinically appropriate pain management. Our findings highlight how real-time negotiation about roles in pain management is needed between interdisciplinary clinicians.

Interdisciplinary providers have identified multiple barriers in coordinating pain management across disciplines. A collaborative process to pain management would include real-time communication and negotiation between disciplines around who will handle opioid prescribing and other aspects of care. For example, we have found both primary and oncologic providers believe one prescriber should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Further, there are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). The field needs approaches to teaming around pain across disciplines.

Want to know more about Karleen? 
Karleen Giannitrapani PhD MPH MA, is an American Social Scientist with expertise applying methods from organizational behavior and implementation science to improve interdisciplinary pain care. She has a PhD in Health Policy and Management from the University of California Los Angeles with a concentration on organizational behavior. Her dissertation (2015) explored determinants of interdisciplinary healthcare team functioning

Dr. Giannitrapani is an Assistant Professor in the Division of Primary Care and Population Health at Stanford University School of Medicine and a Core Investigator at the Center for Innovation to Implementation (Ci2i) in the Veterans Affairs (VA) Palo Alto Health Care System where she is PI or co-investigator on multiple ongoing studies representing over 25 million dollars of competitive government grant funding. She is also a Director of the VA Quality Improvement Resource Center (QuIRC) for Palliative Care, supporting Geriatrics and Extended Care programs for 170 Veterans Affairs facilities nationally. In QuIRC she lead a portfolio of projects on improving the processes that interdisciplinary teams can leverage to improve pain and symptom management among high-risk or frail patients. 

Her expertise includes organizational behavior, building interdisciplinary teams, implementation science, mixed methods-research, and quality improvement, particularly relating to pain management and palliative care.  In contrast to bounded teams with static membership, dynamic teaming reflects the common challenge of interdisciplinary healthcare teams with changing rosters. Such dynamic collaboration is critical to addressing multi-faceted problems and individualizing care. At present, off the shelf interventions to improve the way healthcare teams work - often assume static and bounded teams. Dr. Giannitrapani is leveraging design approaches to build a new kinds of healthcare “teaming interventions,” which respects the nature of their constantly changing membership and more closely aligns with how healthcare teams actually collaborate.

She has numerous publications in high quality medical and health services delivery journals such as Medical Care, JAMA Surgery, the Journal of General Internal Medicine, the Journal of Pain and Symptom Management and Pain Medicine. She has a Career Development Award on building better pain teams across disciplines and has been an American Academy of Hospice and Palliative Medicine Research Scholar for related work.