Patient experience with breast cancer care delivered in a multidisciplinary clinic.
Authors: Graff Stephanie L. , Principe Julie , Fenton Mary Anne Anne , Strenger Rochelle , Dizon Don S. , Begnoche Megan H. , Galvin Anne-Marie 
Published: June 2022

e13506

Background: Multidisciplinary clinics (MDC) are one care model wherein patients can see physicians across specialties and other health professionals in a single appointment and shared space. While multidisciplinary care and MDCs have been studied, little is reported on patient experience. Our group previously reported that over 60% of people seen in a breast cancer (BC) MDC had severe distress at their initial visit, but that same-day MDC visit was associated with a significant reduction in the distress score. This study seeks to better understand the patients’ experience in a BC MDC. Methods: 429 unique patients (pts) identified diagnosed with BC and seen for MDC care from Nov 2020 - Nov 2021 were invited to participate in this RedCap survey via email. 116 (27%) respondents included in this analysis had their initial visit in MDC. Results: Pts demographics were representative of pt population (88% White, 4.3% Black, 3.4% Hispanic; 17.8% < 50yo, 55.9% 50-69yo, 26.3% ≥70yo). Most pts saw 3 physicians during their MDC visit (surgeon 89.4%, medical oncologist 92.0%, radiation oncologist 92%). However, only 23, 21, and 9.7% were seen by a social worker, navigator, or genetic counsellor, respectively. Prior to MDC, the majority (67%) reported being very or somewhat prepared; 15% reported being somewhat or very unprepared. Major positive feedback were that MDC was convenient (89.3%), an efficient use of time (65.2%), and a good way to get questions answered (65.2%); Major criticisms included that MDC was overwhelming (16.1%) and/or too long (4.5%). When asked to rate the top three aspects of MDC, pts chose seeing multiple providers during a single visit (80.4%), communication about the process before and throughout MDC (48.2%), and inclusivity of their support system (38.4%). The top three worst aspects identified included volume of information presented (42.9%), and pts emotional comfort (anxiety, stress) during MDC (30.2%). Among non-White pts, and pts > 70yo, wait time between diagnosis and MDC visit was a notable worst aspect (37.5%, 33.3% respectively).76.4% of pts would choose to be seen for initial consultation in the MDC again, while 14.2% stated that they would choose to have an initial consultation with just one specialist and receive second point of care in MDC. Pts rate overall MDC experience as excellent (83.0%) or satisfactory (12.5%) most of the time. Conclusions: Patients value seeing multiple providers simultaneously in an environment inclusive of their support systems, described as convenient and efficient. There is discordance between 42.9% of pts describing the volume of information presented as a negative aspect of the experience and only 16.1% of pts feeling overwhelmed during MDC. Similar numbers feel unprepared for and overwhelmed by MDC, and implementation of screening tools to identify these pts for alternative care models or to improve preparedness or reduce distress throughout MDC would optimize care for all.