The multidisciplinary care model is perceived to be more patient-centered and efficient for patients with lung cancer than the serial care model, according to Satish K. Kedia, PhD, Professor, Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, TN, and colleagues.1
However, the majority of patients with lung cancer in the United States receive care in community healthcare settings, where multidisciplinary care is often unavailable. The value of a multidisciplinary care model has also not been distinctly proven. The more common serial model of care includes consecutive referrals to specialized healthcare providers, but previous studies have shown that patients can experience delays in their care, or can become mismatched with providers who do not have the appropriate skill sets to meet the patients’ needs.2-4
To further explore the issues regarding lung cancer care delivery, Dr Kedia and colleagues sought direct feedback from patients with lung cancer and their caregivers on their perceptions of serial versus multidisciplinary care models. As part of their analysis, they included 10 focus groups of 22 patients with lung cancer and 24 informal caregivers between March 2013 and January 2014. The patients had completed lung cancer treatment within 6 months, or were receiving lung cancer therapy, in or out of a multidisciplinary care clinic coordinated by a nurse navigator. Verbatim transcripts of audio recordings of each session analyzed, and the authors identified, recurring themes and variants.
Multidisciplinary Care versus Serial Care
One recurring theme in participants’ perceptions of multidisciplinary care included physician collaboration. “Participants preferred multiple specialists working together as a team to decide on the best plan of care,” the authors explained. “They believed that more input from different specialists decreased errors and confusion, resulting in a higher level of trust in the final treatment plan.”
Regarding efficiency, participants reported that the multidisciplinary care model reduced the amount of time spent traveling and waiting for appointments, tests, and visits. Many participants were also satisfied with the open and active patient–physician communication they experienced during the diagnosis and treatment processes, stating that active communication provided them with a sense of comfort. Conversely, the participants who received serial care reported multiple occurrences of insensitive patient–physician communication, such as receiving a phone call to inform them of their initial diagnosis rather than a face-to-face office visit.
Participants were also dissatisfied with the blunt style of communication they received. Another recurring theme among participants receiving serial care was inefficient use of time. Participants were inconvenienced and experienced delays when visiting multiple physicians in several settings. Although many of these participants were generally dissatisfied with serial care, some of them were satisfied with the delivery of care as a result of an open line of communication with providers and quick turnaround time between appointments.
Improving Multidisciplinary Care
In developing patient-centered benchmarks to measure the quality of multidisciplinary care implementation, the authors prompted participants to identify the areas they valued the most. Some of these areas included clear and timely communication between physicians, patients, and caregivers; consistency of physicians’ messages; timely care; and ease of access to care. Participants also distinguished the nurse navigator as the key person for solving issues with coordinating procedures, treatments, and appointments.
Multidisciplinary care was perceived by patients and caregivers as more patient-centered, effective, safe, and efficient than standard serial care, Dr Kedia and colleagues concluded. However, further research is needed to determine barriers to developing multidisciplinary care models. Input from key stakeholders will help develop feasible and effective programs within practice environments that provide lung cancer care.
References
- Kedia SK, Ward KD, Digney SA, et al. ‘One-stop shop’: lung cancer patients’ and caregivers’ perceptions of multidisciplinary care in a community healthcare setting. Transl Lung Cancer Res. 2015;4:456-464.
- BTS recommendations to respiratory physicians for organising the care of patients with lung cancer. The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. Thorax. 1998;53(Suppl 1):S1-S8.
- Salomaa ER, Sällinen S, Hiekkanen H, Lippo K. Delays in the diagnosis and treatment of lung cancer. Chest. 2005;128:2282-2288.
- Ost DE, Niu J, S Elting L, et al. Quality gaps and comparative effectiveness in lung cancer staging and diagnosis. Chest. 2014;145:331-345.
