Interdisciplinary Care Rounds in a Community Cancer Center: Changing the Paradigm of Supportive Service Involvement in Cancer Care

Background: Cancer centers have focused on optimizing seamless multidisciplinary care at tumor boards and/or clinics, but little has been published on effective ways to involve supportive services in the management of cancer patients. The IOM 2008 report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,¹ related high-quality healthcare to the “level of interactions among different clinicians serving the same patient.” Bon Secours St. Francis Cancer Center (BSSF) program included palliative medicine (PM), oncology rehabilitation service (ORS), and other supportive care services. These programs were underutilized for oncology patients. Referrals for January through June 2014 were as follows: PM, 204 total visits, with a monthly average of 34; ORS, 92 total visits, with a monthly average of 15, and referrals to the American Cancer Society (ACS) were 23 for January through November 2014, with a monthly average of 2 referrals.

Objectives: BSSF initiated interdisciplinary care (IDC) rounds to increase referrals to supportive care services—PM, ORS, and ACS.

Methods: In September 2015, IDC rounds were initiated. IDC rounds participants represent the following areas: medical oncology, navigation, clinic nursing, PM, financial counseling, psychology, nutrition, home care, hospice, Adolescent and Young Adult (AYA) program, ORS, and ACS. Patients with malignancies are discussed within 3 weeks of presentation and at any point during the continuum of care, and a treatment strategy formulated. A database was created to track new patients and record the recommendations of this weekly discussion, which are then forwarded to the primary medical oncologist for review and approval. Nurse navigators are pivotal to the process. They anticipate needs for supportive services that may not be evident during other points of contact. The team relies on navigation for identification of needs during IDC rounds.

Results: Referrals for January through May 2016 were as follows: PM, 334 total visits, with a monthly average of 67; ORS, 134 total visits, with a monthly average of 27; and 291 referrals to the ACS, with a monthly average of 58.

Conclusions: Our results demonstrated referrals to supportive services have increased since the introduction of the IDC rounds. IDC rounds increased the involvement of supportive care services and improved the interaction between care team members.

Reference

1. The Psychosocial Needs of Cancer Patients. In: Adler NE, Page AEK, eds. Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: National Academies Press (US); 2008.