Training Health Care Professionals in Interprofessional Collaborative Cancer Care

Today’s health care professionals need training to be able to practice in an interprofessional collaborative environment. Trainees learning to provide quality cancer care benefit from exposure to and immersion in interprofessional patientcentered team-based care. A large Midwestern Veterans Affairs Medical Center was awarded a three year grant to integrate interdisciplinary and interprofessional collaborative practice into an ambulatory cancer clinic and to train interdisciplinary health care professional learners in this model of cancer care. A core curriculum was developed to prepare trainees in veteran-centered collaborative cancer care, and clinical experiences were designed to involve trainees in the care provided by all disciplines. The impact of this interprofessional model of care on patient and trainee outcomes is emphasized. Feasibility and sustainability of the model are also discussed. Received: 09/12/2014 Accepted: 08/09/2015 Published: 10/15/2015 © 2015 Arfons et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Training Health Care Professionals in Interprofessional Collaborative Cancer Care EDUCATIONAL STRATEGY 2(3):eP1073 | 2 Introduction Training health care professionals to meet the complex health care demands of today’s patients requires that they are well prepared to practice in an interprofessional collaborative environment. Historically, clinical training has been discipline-specific, with little opportunity to engage in inter-professional experiences (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011). With the challenges of the burgeoning health care system, practitioners must be trained to provide care collaboratively rather than in isolation so as to prevent medical errors and decrease duplication of services and health care cost. Health care professionals trained in interprofessional collaborative practice are more likely to demonstrate respect for other professionals’ roles and responsibilities and to become collaborative members of the team (Barker & Oandasan, 2005). Ultimately, this collaboration has been shown to improve patient outcomes of quality and safety for a variety of acute and chronic illnesses such as cancer and diabetes (Gagliardi, Dobrow, & Wright, 2011; Litaker et al., 2003). Interprofessional education has been defined as “an intervention where the members of more than one health or social care profession, or both, learn interactively together, for the explicit purpose of improving interprofessional collaboration (IPC) or the health/wellbeing of patients/clients, or both” (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). Many medical schools and nursing programs are beginning to integrate interprofessional practice education into their curricula. Programs offer didactic sessions and many are now introducing interprofessional clinical experiences where the application of the principles of collaboration, communication, and respect are encouraged (Owen, Brashers, Peterson, Blackhall, & Erickson, 2012). In 2011, the Interprofessional Education Collaborative issued “Core Competencies for Interprofessional Collaborative Practice (IPCP): Report of an Expert Panel. ” The expert panel included representatives from the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health. They established the four essential competency domains: 1) Values/Ethics for Interprofessional Practice; 2) Roles/Responsibilities; 3) Interprofessional Communication; and 4) Teams and Teamwork. Within each essential domain are a number of behaviors that demonstrate competencies associated with that domain. These competencies are obtained over three phases at the pre-licensure level: exposure, immersion, and competence. At the graduate level, the emphasis is on mastery. For graduate trainees who have not been introduced to interprofessional collaboration, exposure, and immersion are still the steppingstones to competency (Interprofessional Education Collaborative Expert Panel, 2011). This paper is a report of a three-year interprofessional grant-funded project at a large Midwestern Veterans’ Affairs Medical Center (VAMC) ambulatory cancer clinic. The goals of the project were to 1) integrate the principles of interprofessional collaboration into an interdisciplinary clinic to improve the quality of cancer care and 2) to educate heath care professional trainees from a variety of disciplines in interprofessional practice by providing them with opportunities for collaboration, exposure, and immersion into interprofessional collaborative practice. A critical component of this exposure and immersion was the emphasis on a quality experience rather than on numbers of patients seen. Quality rather than quantity made the educational experience much richer for the trainees than other more traditional clinical rotations. Louis Stokes Cleveland Veteran’s Affairs Medical Center Model of IPC The Louis Stokes Cleveland VAMC was awarded a grant from the Offices of Academic Affiliations and Specialty Care to fund a three year project, “Transforming and Integrating Medical and Surgical Expertise” (TIE). This project involved the development of an interprofessional and interdisciplinary cancer clinic that provides patient-centered specialty care for veterans with selected cancers of breast, melanoma, sarcoma, and lymphomas. The selected cancer population was based on faculty expertise. Veterans were referred to the Center of Excellence (CoE) cancer clinic with a cancer concern, a new diagnosis of H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu. edu/hip 2(3):eP1073 | 3 cancer, ongoing cancer treatment, and/or survivorship. Outcomes of the project were timely access to quality cancer care, coordinated interdisciplinary consultations, and interprofessional team-based care that includes referring primary care providers. In order to implement the interprofessional clinic successfully, the faculty of the CoE were trained in team interaction and spent the first six months learning about interprofessional collaborative practice (Silver & Leslie, 2009). Learning sessions focused on identifying roles and responsibilities, valuing and respecting each other’s disciplines, and learning communication strategies to work effectively as a team. Policies and procedures were developed for each discipline within the team, for the team as a whole unit, and for referral to the CoE specialty care clinic. This learning process was completed before trainees were brought into the clinic setting. The Interprofessional Clinic Collaborative Practice The Specialty Care–Cancer CoE clinic was designed around the patient. Most patient appointments were made with either the physician (medical and/or surgical oncologist) or the advanced practice nurse whose role was the survivorship nurse practitioner (NP). Depending on patient needs, the social worker, psychologist, clinical nurse specialist (CNS) patient navigator, and/ or other disciplines participated in the veteran’s clinic appointment. In true interprofessional manner, all disciplines needed for quality cancer care saw the veteran at that clinic appointment. This process allowed the patient to stay in his/her outpatient exam room rather than traveling around the clinic for appointments with other disciplines or having to come back another day. The trainee(s) assigned to the patient stayed with the patient during all professional encounters. This educational experience gave the trainees the opportunity to learn roles and responsibilities of each member of the interdisciplinary team. The clinic day began with a team meeting 7:30–9:00 AM. The pre-clinic meeting provided an opportunity to role-model team-based, patient-centered care for the trainees (Shunk, Dulay, Chou, Janson, & O’Brien, 2014). The meeting helped to strengthen collaboration among team members, structured the team scheduling for the day, and encouraged a holistic approach to veteran problems and concerns. All patients scheduled for that day were reviewed in the morning; past history and current treatment plans were discussed. All team members involved in the patient’s care contributed to the discussion. Patients were seen from 9:00 AM–12:00 noon. Patient appointments were scheduled every half-hour to allow time for trainees to work closely with each veteran and their family members as well as other members of the team. At noon, there was an hour teaching conference, and patients were scheduled again from 1:00–2:30 PM so that the team could meet again from 3:30–4:30 PM to review patient care and provide additional teaching opportunities. Trainees were expected to discuss their patients with the team during the afternoon meeting and to seek input from the disciplines involved in the treatment plan. As part of the project, distress screening and manage-ment was a major focus of quality cancer care. All veterans participated in distress screening at every visit. The veterans were given the National Comprehensive Cancer Network® (NCCN®) distress thermometer (DT) at check-in at every visit by the receptionist and were asked to fill it out prior to their clinic visit. The DT addresses the multiple dimensions of cancer-related distress (Figure 1, following page). According to the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®), scores of 4 or more require intervention (NCCN Guidelines® for Distress Management, V.2.2013). The RN on the team reviewed the distress screening responses and alerted the appropriate disciplines depending on patient’s overall score and endorsed components of di