Care delivery and biomarker testing for people with colorectal cancer receiving 4R care sequence plans.
Authors: Kalyan Aparna , Weldon Christine B. , Trosman Julia R. , Benson III Al Bowen , Valero Danielle , Back Nicole , Davis Anjee , Ripley-Burgess Danielle , Getty Zac , Kircher Sheetal Mehta 
Published: January 2025

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Background:
The 4R Oncology model has shown improvements in patient knowledge of care and timing/sequence of key care events (1,2) but has not been studied in colorectal cancer specific. 4R is Right Info/Care/Patient/Time. The 4R Care Sequence is a patient-facing care plan describing the course and timing/sequence of care. Here we report the impact of using 4R for patients with colorectal cancer.
Methods:
We tested the impact of 4R care sequence plans on patient reported biomarker testing and care delivery referrals and receipt of services at a colorectal cancer program via patient surveys. 4R Plans were provided to patients from Sept ‘23 – Aug ’24 (4R cohort). Patient-reported data were analyzed to compare the 4R cohort (N = 19) to a control cohort of patients who received care pre-4R, Sept ‘22 – Aug ’23 (N = 60). Used Fisher’s exact test.
Results:
Response rates: 4R cohort 79% (19/24), Control cohort 87% (41/47). Comparing the 4R cohort to the control cohort respectively, patients were male (47%, 54%), White (89%, 76%), average age (57, 52), and reported income less than $30,000 (21%, 24%). The 4R cohort significantly improved care delivery in five metrics, and directionally improved in care delivery metrics compared to the control cohort (table). One biomarker testing metric significantly improved and other biomarker testing metrics directionally improved in the 4R cohort vs. the control cohort (Table).
Conclusions:
The use of 4R Care Sequence plans for patients with colorectal cancer facilitated improvements in care delivery and patient ‘s awareness of biomarker testing. While there were directional improvements in all metrics, there is opportunity and room for additional improvements. The team will continue to work on efforts to improve these metrics and optimize the use of 4R Care Sequence plans for patients with colorectal cancer. 1. Trosman 2021. 2. Liu 2023.

Referral and receipt of services, biomarker testing.

4R chortN=19
Control cohort N=41
Pvalue

Did your provider recommend you see a nutritionist/dietitian?
89%
20%

0.0001

If Yes, did you see a nutritionist/dietitian ?

84%

20%

0.001

Did your provider recommend you see your primary care physician about staying as healthy as possible during care treatment?
95%
29%

0.0001

If Yes, did you see your primary care physician?

95%

67%

0.04

Did your provider recommend you get support for transportation, food, housing, insurance, or other needs?
42%
12%

0.01

If Yes, did you get support for these needs?

88%

67%

0.4

Did you provider recommend you get help for emotional distress or worry?
53%
46%
0.4

If Yes, did you get help for emotional distress or worry?

70%

47%

0.2

Did your care providers talk to you about biomarker testing after your cancer diagnosis?
53%
37%
0.2

If yes, how clear was it to you why biomarker testing was or was not recommended for you?

90%

73%

0.3

Did you get biomarker testing?
63%
34%

0.03

Did your care providers discuss results of biomarker tests with you?
92%
87%
0.6