Intentional approach to team-based oncology care: evidence-based teamwork to improve collaboration and patient engagement.

At the risk of sounding trite, high-quality cancer care takes a village. As patients journey along the continuum of cancer care—including risk assessment, prevention, diagnosis, treatment, advanced cancer, surveillance, and survivorship—coordination among multiple groups of clinicians is required. Within any given clinic, complex therapies require clinicians with advanced, specialized training. Clear communication and transparent, defined roles and responsibilities help ensure that care needs are addressed and timely decisions are made. Placing prompts in electronic health records, sending reminders to patients, and requiring detailed notes at transfers of care are important strategies to improve communication. Embedding these kinds of tools in the process helps address issues in the immediate, but more lasting change can come from explicitly helping to transform individual clinicians and separate groups into a team that works together. In this issue, Taplin et al present an overview of cancer care team effectiveness and use a case-based vignette to discuss the importance of delivering cancer care as a team. The manuscripts mark the beginning of a collaboration between the National Cancer Institute (NCI) and ASCO to bring clinicians, patient advocates, and researchers together to explore application of the evidence of team effectiveness to clinical practice. The NCIASCO Teams in Cancer Care Delivery Project will unfold at a February 25, 2016, workshop, prior to the ASCO Quality Care Symposium, and through submission of manuscripts to Journal of Oncology Practice (see www.ASCO.org/Teams). Teams are defined as two or more people who “interact dynamically, interdependently, and adaptively” to accomplish a shared goal. Weaver et al assessed the role of interprofessional teams in an inpatient oncology setting and concluded that nurses and oncologists have disparate perceptions of the effectiveness of their collaboration and work as a team. In an editorial that accompanies the article, Childress questioned the need for additional studies to demonstrate “significant and well documented” differences in perception of communication. Taplin et al note that communication is one of the eight hallmark traits of effective teams. The hypothesis the NCI-ASCO project will discuss is that deliberately identifying and enhancing team interactions in oncology care will help improve cancer care delivery. As a first step, Taplin et al take us through a review of the evidence to support team-based practice from other settings and in cancer therapy. This project fits in the larger context of the transformation of health care delivery and payment models. The field of primary care has actively engaged in reinventing care through the formation of patient-centered medical homes. Experiments are underway to apply the same concepts to specialty care delivery. At the same time, public and private payers and ASCO are proposing payment models that would move away from payment based on specific procedures and physician contributions and toward an approach that would provide bundled payments for comprehensive care and allow greater flexibility in how care is organized and delivered. A team-based approach has potential to leverage these changes, provide an opportunity to reexamine clinician roles and responsibilities, and enable the most efficient delivery of high-quality health care services. Clinicians in oncology care may believe that their practice already involves working in teams. Indeed, people with cancer expect that the many clinicians they engage across their care continuum will deliver a coordinated and seamless experience. However, oncology care may not always meet this standard, and the responsibility of coordinating care may typically fall on the patient or their caregivers. Could consideration of cancer care through patients’ eyes improve quality, access, efficiency, and clinical outcomes? Should the person with cancer have an explicit role and set of responsibilities within the treatment team? If clinicians approach patients with this question, would they embrace a role in the team or believe the clinician is trying to avoid responsibility? Could working in teams with well-recognized and valued roles for all team members improve job satisfaction and reduce provider burnout? These questions have many possible answers. This NCI-ASCO initiative is aimed at encouraging exploration of these issues to better understand how teams currently operate and where improvements may help. The literature in health care and many other fields demonstrates that effective teamwork takes time and intentional focus to nurture, develop, and sustain. To this end, we issue a call for participation to engage in this process. We hope this collaboration of clinicians involved in cancer care, advocates who have had cancer or been caregivers, and researchers engaged in studying teams will highlight successful models and identify areas for future research. Leaders of the initiative will invite applicants to serve on writing groups to apply principles of team-based care to specific case scenarios. The writing groups will meet in person and work by conference call and e-mail to develop a preHealth Care Delivery