Interdisciplinary Cancer Care Team Composition and Communication Alicia Sprecher Mentors: Sarah Davis and Kathleen O’Connell The Center for Patient Partnerships

Introduction to Cancer Care

!   Largely Interdisciplinary1-4

!  Barriers to team success time, distance, personalities1,5,6

This Study

!   Dynamics of one cancer care team

!   Team defined by those providers interacting with single patient

!   Define composition of cancer care team

!   Identify positives and negatives in current communication practices

Methods - Subjects

!   One patient selected !   Involvement with Center for Patient Partnerships !   Completed active treatment

!   Patient identified other team members to be recruited !   Urologist !   Oncologist !   Oncology nurse !   Primary care provider !   Staff member from Gilda’s Club !   Patient Advocate from the Center for Patient Partnerships

!   Addition individuals recruited !   2 additional oncologists !   Patient relations specialist for the UW Hospital

Cancer Care Team Composition

Physician, nurses, MA, support staff, pharmacist

Specialized nursing roles, additional physicians (surgery, radiation),

nutritionist, psychiatry/psychology

PCP, patient, patient advocate, social support (Gilda’s Club),

patient navigator, complimentary medicine

Existing Improvements – Tumor Boards

Improved diagnosis, provider

satisfaction & adherence to standard of

care2,3.4

Improved respect between

providers5,7

Better understanding

of provider roles5,7

More immediate feedback and exchange of

ideas

Recommendations - Flagging

!   Draw attention to requests for action or particular concerns

!   Especially valuable when patient has appointments with non-oncology specialists

!   Increases likelihood that pertinent information is transmitted

!   May contribute to improved problem lists

Recommendations – Patient Navigator

• Lay person • Nurse

Individual Characteristics8

• Coordinating appointments, liaison between providers • Liaison to social support • Patient education

Activities8

• Improved time to diagnosis • Decreased patient anxiety and distress • Better completion of treatment and preparedness for

appointments

Benefits8-11

Recommendations – Improved Patient Involvement

!   Patients desiring increased involvement in the cancer care team5,6

!   Patient knowledge about purpose of new providers

!   Expectations for appointments with new providers

!   Assurance that providers are communicating

Conclusions

!   Interdisciplinary tumor boards

!   Patient involvement

!   Flagging

!   Patient navigation

!   Limitations !   Only one team investigated

!   Comprehensive cancer center setting

Questions?

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Oncol Pract. 2010; 6(6):281-283 2  Lamb BW, Sevdalis C, Taylor C, Vincent C, Green JSA. Multidisciplinary team working across different

tumour types: analysis of a national survey. Annals of Oncology. 2011 [In Press]. 3  Palmer G Martling A, Cedermark B Holm T. Preoperative tumour staging with multidisciplinary team

assessment improves the outcome in locally advanced primary rectal cancer. Colorectal disease. 2010;13(12):1361-9.

4  Kurpad R, Kim W, Rathmell WK, Godley P, Whang Y, Fielding J, Smith L, Pettiford A, Schultz H, Nielson M, Wallen EM, Pruthi RS. A multidisciplinary approach to the management of urologic malignancies: Does it influence diagnostic and treatment decisions? Urologic Oncology: Seminars and Original Investigations. 2011;29:378-382.

5  Bahal N, Papanikitas A, Sokol DK. A bleeding controversy: Duties and decisions in the face of conflicting advice. International Journal of Surgery. 2010;8:32-34.

6  Ueno NT, Ito TD, Grigsby K, Black MV, Apled J. ABC conceptual model of effective multidisciplinary cancer care. Nat Rev Clin Oncol. 2010;7:544-547.

7  Lamb B, Payne H, Vincent C, Sevdalis N, Green JSA. The role of oncologists in multidisciplinary cancer teams in the UK: an untapped resource for team leadership. Journal of evaluation in Clinical Practice. 2011a;7(16):1200-6.

8  Gilbert JE, Green E, Lankshear S, Hughes E, Burkeski V, Sawka C. Nurses as patient navigators in cancer diagnosis: review, consultation and model design. European Journal of Cancer Care. 2011;20:228-236.

9  Campbell C, Craig J, Eggert J, Bailey-Dorton C. Implementing and measuring the impact of patient navigation at a comprehensible community cancer center. Oncology Nursing Forum. 2010;37(1)::61-68.

10  Swanson J. The role of the oncology nurse navigator in distress management of adult inpatients with cancer: A retrospective study. Oncology Nursing Forum. 2010;37(1):69-76.    

11  Palos GR, Hare M. Patients, family care givers and patient navigators: A partnership approach. Cancer. 2011;117(515):3590-3600.

12  Poulin-Tabor D, Quick RL, Wilson L, Orff S, Gallant P, Swan N, Manchester N. Pioneering a new role: the beginning, current practice and future of the clinical nurse leader. Journal of Nursing Management. 2008;16:625-626.