Chronic diseases — such as diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD) or cancer — represent one of the greatest challenges of modern medicine. They require long-term, integrated care that takes into account the diverse aspects of the patient's physical, mental and social health. In this context, interdisciplinary teams play a key role — groups of specialists from different fields working together to provide the best possible care for the patient.

Composition of interdisciplinary teams

An interdisciplinary team may include:

• doctors of various specialties (e.g. internists, cardiologists, oncologists) who diagnose and develop individual treatment plans,
• nurses who monitor the patient's health, carry out medical orders and support health education,
• nutritionists who adapt nutritional plans to the individual needs of the patient,
• psychologists who support patients in coping with emotional challenges
• physiotherapists responsible for improving the mobility and quality of life of the patient,
• social workers supporting the patient in social and formal matters.

Each of these professionals brings a unique perspective and competence, which allows for a comprehensive approach to patient care [3].

The benefits of teamwork

1. Better quality of care — the cooperation of specialists from different fields makes it possible to create comprehensive treatment plans, taking into account all aspects of the patient's health. Effective coordination of care minimizes the risk of errors and prevents duplication of actions, which in turn leads to significant improvements in patient health outcomes [1].‍
2. Involvement of the patient in therapy — interdisciplinary teams contribute significantly to deepening the patient's understanding of his disease and the treatment process. Effective patient education not only increases their commitment to therapy, but also directly translates into better treatment outcomes [3]. This synergy of knowledge and active patient participation forms the foundation of effective health care for chronic diseases.‍
3. Reducing the risk of complications — thanks to regular team meetings, discussions and exchange of information between specialists, it is possible to react quickly to changes in the patient's state of health. This reduces the risk of complications and hospitalization [2].

The role of education of the patient and his loved ones

Education is the foundation of effective care for patients with chronic diseases. Interdisciplinary teams actively involve patients and their families in the therapeutic process. They provide them with crucial information about illness, healthy lifestyles, and methods of dealing with health challenges. A patient who has an in-depth understanding of his or her health needs is more likely to follow medical advice and effectively manage his or her illness [1].

Challenges in the work of interdisciplinary teams

Despite numerous benefits, interdisciplinary teams also face challenges such as:

• difficulties in communication between team members,
• conflicts arising from differences in treatment approaches,
• problems managing roles and responsibilities in the team [3].

Effective cooperation therefore requires clearly defined goals, open communication and mutual respect.

Examples from clinical practice

Interdisciplinary teams are the standard of care in many areas of medicine, especially where a comprehensive approach is crucial for effective treatment and improved quality of life for patients. Here are more detailed examples of how they work in clinical practice:

1. Oncological care

In the treatment of cancer patients, interdisciplinary teams include oncologists, surgeons, radiation therapists, oncological nurses, nutritionists, clinical psychologists, and sometimes also social workers.

• The role of interdisciplinarity: a patient with cancer may require surgery (surgeon), treatment with chemo- or radiotherapy (oncologist, radiotherapist), dietary support to improve nutritional status (nutritionist), and psychological help to cope with anxiety and depression (psychologist) [4].
• Application example: in a patient with colon cancer, an interdisciplinary team develops an individual treatment plan. This plan includes surgery to remove the tumor, adjunctive therapy, and an assessment of the risk of recurrence of the disease — all based on specialist consultation. Such a comprehensive approach minimizes complications and increases the patient's chances of survival [5].

2. Treatment of type 2 diabetes

In the care of patients with diabetes, interdisciplinary teams may include diabetologists, nutritionists, educational nurses, physiotherapists and psychologists.

• The role of interdisciplinarity: the diabetologist introduces drug therapy, the nutritionist develops an individual nutrition plan for the patient, the physiotherapist supports him in increasing physical activity, and the psychologist helps to cope with motivation and stress [6].
• Application example: in a patient with advanced diabetes and complications such as diabetic neuropathy, the team develops a treatment plan, including pharmacotherapy, exercise rehabilitation and educational support. An interdisciplinary approach improves glycemic control and patient quality of life [7].

3. Palliative care

In palliative care, interdisciplinary teams focus on improving the quality of life of patients with advanced, incurable diseases. These teams may include palliative medicine doctors, nurses, psychologists, clergy and social workers.

• The role of interdisciplinarity: the team collaboratively sets care priorities such as pain relief, symptom management (e.g. shortness of breath), emotional and spiritual support, as well as help with social problems [8].
• Application example: in a patient with advanced lung cancer, the palliative syndrome focuses on pain management (doctors), psychological support (psychologist), improvement of respiratory comfort (physiotherapist) and organization of home care (social worker) [9].

4. Rehabilitation after a stroke

Patients after a stroke require comprehensive care, including neurologists, rehabilitators, speech therapists, nutritionists, psychologists and nurses.

• The role of interdisciplinarity: a neurologist monitors the patient's condition, a rehabilitator creates a program of remedial exercises, a speech therapist deals with speech disorders, and a psychologist helps to cope with post-traumatic depression [10].
• Application example: for a patient with hemiparesis after a stroke, the team develops a comprehensive rehabilitation plan. It includes movement exercises, speech therapy and nutrition education, which aims not only to improve the patient's condition, but also to prevent further stroke incidents [11].

summary

In the face of an aging society and a growing number of patients with chronic diseases, the role of interdisciplinary teams is becoming increasingly important. Implementing this model of care on a broader scale — especially in primary and specialist healthcare settings — can have long-term benefits for both patients and the health care system as a whole.

However, in order to fully exploit the potential of interdisciplinary teams, investments in staff education, the development of technologies that support communication between specialists and the promotion of awareness among patients of the benefits of such an approach are necessary.

Ultimately, interdisciplinary care not only increases the effectiveness of treatment, but also improves the quality of life of patients, making it an indispensable element of modern medicine.

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1. Heading Home To Dinner, (2021), Dlaczego praca zespołowa w opiece zdrowotnej jest ważna? https://headinghometodinner.org/pl/dlaczego-praca-zespołowa-w-opiece-zdrowotnej-jest-ważna/
2. IWOFR, (2021), Plany opieki interdyscyplinarnej: Praca zespołowa sprawia, że marzenia się spełniają, https://iwofr.org/pl/plany-opieki-interdyscyplinarnej-praca-zespołowa-sprawia-że-marzenia-się-spełniają/
3. Kościołek M., pod red. Nowobilski R., (2021), Interdyscyplinarny zespół terapeutyczny w świetle obecnych wyzwań systemu ochrony zdrowia w Polsce. Ocena otwartości na współpracę w zespołach terapeutycznych studentów wybranych kierunków medycznych
4. Kowalski J., (2020), Nowoczesne podejście do opieki onkologicznej
5. Smith R., (2018), Multidisciplinary Teams in Colorectal Cancer Treatment
6. Jones M., (2019), Diabetology and Interdisciplinary Care, Journal of Diabetes Research
7. Nowak A., (2011), Edukacja w leczeniu cukrzycy, [W:] Medycyna Praktyczna
8. Johnson P., (2017), Palliative Care and Interdisciplinary Practice
9. Kowalska E., (2022), Holistyczne podejście w opiece paliatywnej
10. Lee T., (2019), Stroke Rehabilitation: An Interdisciplinary Approach
11. Wojciechowski K., (2020), Rehabilitacja poudarowa w Polsce