Objective: In a suburban community hospital where turnaround times for hormone receptor reports of positive breast biopsies averaged 8 business days, resulting in delayed initiation of treatment, an interdisciplinary breast [ Read More ]
October 2016 VOL 7, NO 9
24. Second Opinion? Have Ten! Do MDMs Make a Difference in the Patients’ Plan of Care?
Amy M. Norton, RN, MSN; Erin L. Terwilliger, RN, BSN
Sarah Cannon Cancer Network – HCA Midwest Health
Background: According to El Saghir and colleagues,1 “Tumor boards (multidisciplinary meetings – MDMs) can be seen as a form of second opinion conducted by a group that includes case review, evidence-based recommendations, and expert opinions” and “provide patients with cancer the potential benefit of having physicians of various specialties participate in treatment planning.” This has also “led to better team dynamics and communication, improved patient satisfaction, and improved clinical outcome.”1 Scher and colleagues2 state “Previous studies looking at multidisciplinary clinical approaches to cancer treatment have shown improvements in quality of care measures and patient satisfaction.”
Purpose: To show potential change to patient’s treatment plan with the case presentation at a multidisciplinary conference.
Methods: For the period from April 2015 to June 2016, patient cases are presented at a tumor board conference made up of a multidisciplinary team. One physician presents each case with a preliminary plan, and the team discusses and offers input and alternative ideas and methods. Patient treatment plan changes are recorded in navigation software after the conference. Data were compiled through reports available by month, year, and tumor type.
Results: Over a period of 15 months, a total of 277 patients were recorded in the software as being presented at MDMs; 158 of these patients’ treatment plans were recorded as “changed” as a result of the MDMs. Overall, 57% of our total patients presented had a change from the initial plan of care for the Kansas City market.
Conclusion: Multidisciplinary conferences are an extremely valuable tool utilized by navigators to ensure their patients are being offered the most inclusive care, with access to many disciplines and opinions at once. This level of care provided by the multidisciplinary conference second opinion potentially increases patient satisfaction, thereby increasing the value of the program.
Implications/Limitations: Although further studies are needed to determine long-term outcomes or value propositions for a multidisciplinary approach, it has been widely accepted among the patient community as a favorable step toward a personalized approach to their treatment plan. Nurse navigators have the opportunity to advocate on the patients’ behalf, thus aiding in the alignment of the patients’ goals of care and, incidentally, their retention.
- El Saghir NS, Keating NL, Carlson RW, et al. Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide. Am Soc Clin Oncol Educ Book. 2014;e461-e466.
- Scher KS, Tisnado DM, Rose DE, et al. Physician and practice characteristics influencing tumor board attendance: results from the provider survey of the Los Angeles Women’s Health Study. J Oncol Pract. 2011;7:103-110.
20. Overcoming Barriers to Lymphedema Education and Treatment for Breast Cancer Patients in Rural Eastern North Carolina
Background: Approximately 42% of breast cancer survivors develop clinically detectable lymphedema within 5 years of treatment. Lymphedema risk factors include axillary node surgery, radiation therapy, infection, tumor growth, and obesity. [ Read More ]