Purpose: Cancer care has become increasingly complex, requiring cancer patients to be seen concurrently by several specialists and undergo multiple tests and procedures. The high prevalence of coexisting medical and mental health conditions in patients further complicates the early detection, diagnosis, and management of cancer. In addition, barriers to care (financial, transportation, and housing problems, etc) contribute to poor compliance and delayed diagnosis and treatment, resulting in poor outcomes. Any combination of these factors can cause significant stress for patients, their families, providers, and the health care system as a whole, affecting the cost and quality of care.
Methods: Our approach to establishing the Cancer Care Coordination (CCC) program within our Medical Oncology service was multifaceted in order to meet the unique needs of both the patients and our facility. We first reviewed existing literature to identify essential components needed to build an effective, comprehensive model of care coordination. We then consulted with oncology experts to determine the feasibility of the identified interventions. Next, we designed a patient navigation tool using Microsoft Access software. The goal of designing this tool was twofold. First, we wanted to build an effective tool to serve as a long-term monitoring and care coordination device for oncology patients. Second, we designed the tool to collect data for a comprehensive needs assessment and the future strategic planning of the program. In addition, we created a specific intake form for use by the cancer care coordinator to gather data in a structured format and designed various patient and family education materials. We used mixed-method analysis to evaluate the effectiveness of the program. In addition to quantitative analysis, we conducted semistructured patient interviews to gain insight into their perspectives and experiences.
Results: Since the CCC program’s inception in 2013, 84 patients have been referred to the program for care coordination. Stratifying cases by cancer diagnosis, we identified that, of the 84 cases, the majority (61 cases, 72.6%) had lung cancer, 9 (10.7%) had esophageal cancer, and 14 (16.6%) had other cancers (colorectal, renal, testicular, hepatocellular, and prostate). All cases had at least 1 coexisting health condition. Financial and transportation issues were among the top concerns identified by patients as barriers to care. Patient and caregiver knowledge pertaining to diagnosis and treatment options, as well as assistance with appointment coordination in a timely manner, were identified by patients as essential components of cancer care coordination. The patient navigation tool allows the coordinator to print daily, weekly, and monthly reports (upcoming appointments, monitoring plans, etc), using widely available Microsoft Office products thus providing a viable tool for care mapping and care coordination. Although this tool is not directly linked to computerized medical records necessitating manual entry of patient data, a major advantage is absence of a maintenance fee or additional software expenses. The tool can be readily adapted by other programs.
Conclusions: The results of our literature review and consultation with oncology providers confirmed a wide variation in practices of cancer care coordinators. Although there is a substantial amount of recent literature describing the benefits of cancer care coordination, we did not identify a readily adaptable model of such coordination that met our goals and needs. We attribute this to the unique requirements of each facility. Therefore, we suggest that conducting a careful needs assessment is paramount in the early stages of program development to matching the population and organizational needs to the services the program offers.
