Background: Lung cancer is the leading cause of death in the United States, with approximately 235,760 new cases and 131,880 deaths expected to occur in 2021. Lung cancer patients are often diagnosed at later stages of disease due in part to lack of education about lung cancer screening requirements. Patients are often overwhelmed and struggle to balance understanding their disease while managing multiple diagnostic and treatment appointments and their mental and spiritual health. Evidence supports that diagnostic workups taking longer than the median time are often due to the multiple clinical evaluations required for accurate staging.
A cancer center in Texas identified that lung cancer patients were required to travel to the hospital 4 separate days for diagnostic appointments and consultations before beginning treatment. An opportunity for improved coordination of care during the diagnosis to treatment phase was identified to support a positive patient experience, improve patient and provider satisfaction with care, and prevent any potential delays in care.
Objective: To improve timely accessibility to care for lung cancer patients using a coordinated pathway to expedite care from diagnosis through treatment.
Methods: A quality improvement project was conducted by forming a multispecialty task force and assessment of the lung cancer patients’ care pathway to identify barriers or opportunities to improve timeliness to care. The team comprised medical oncology, radiation oncology, thoracic surgery, nurse navigation, imaging, scheduling, cancer center and oncology service line administrators, and the cancer registry. The team identified that the oncology nurse navigator (ONN) would review each patient’s chart to determine if imaging desired by the oncologist had already been performed. The ONN would then coordinate with the oncologist who would order imaging and/or request additional consultation appointments. The ONN would contact each patient to confirm their awareness of referrals, introduce them to the program, and inquire about their willingness for same-day appointments. The ONN would then collaborate with all departments, finalize appointments, and send a detailed itinerary to the patient. Dedicated staff was appointed in each department to expedite scheduling and escalate appointments. The team aimed for staging images to be completed prior to consultations and same-day multidisciplinary appointments. Patient cases were subsequently presented during tumor boards with ease of collaboration after completion of all consults. Patients were surveyed for feedback on same-day consultations.
Results: Eighty-two new lung cancer patients were seen from July 1, 2020, to June 30, 2021. Days from first consultation to treatment start were reduced from 24.5 to 18 days (26%). One hundred percent of tobacco users received tobacco cessation counseling from the ONN. Twenty-eight percent of patients elected to have all first consultations the same day. Survey results revealed 25% of the patients agreed and 68.75% strongly agreed that same-day consultation was a good use of their time.
Conclusion: Incorporating navigation into the lung cancer program reduced the number of visits experienced during the staging phase, thereby reducing days from consult to treatment by 26%. The pathway established a defined process to support patients to navigate throughout their continuum of care. Appointment scheduling was streamlined with improved timeliness of care, reduced appointments and delays in care, and improved patient satisfaction.
