Incorporating Patient Satisfaction Metrics in Assessing Multidisciplinary Breast Cancer Care Quality

The Institute of Medicine’s report on the quality of US cancer care asserts, “Cancer care is often not as patient-centered, accessible, coordinated, or evidence based as it could be, detrimentally impacting patients.”1 This report defines six components of a high quality cancer care delivery system: engaged patients; an adequately staffed, trained, and coordinated workforce; evidence-based cancer care; a learning healthcare information technology system; translation of evidence into clinical practice, quality improvement, and performance improvement; and accessible, affordable cancer care.1 In an effort to incorporate these high quality cancer care elements, a new model for breast cancer care delivery was implemented at the Medical University of South Carolina (MUSC) in August 2012, based on the model examined and reviewed by Fennell et al.2 In the multidisciplinary breast clinic (MDBC) model, the MDBC team meets weekly for a morning tumor board to prospectively review all new patients being seen in clinic that day. The MDBC team includes representatives from the medical specialties of medical oncology, surgical oncology, radiation oncology, pathology, radiology, and psychology. The team also includes genetic counselors, nurse navigators, and patient navigators, and community health workers who help address logistic and sociocultural barriers to care. In preparation for a patient consultation with the MDBC team, the nurse navigators facilitate the collection of all relevant imaging, pathology, and medical records. The nurse navigators contact patients to coordinate appointments and to introduce the MDBC model of care. All patients’ medical records are placed in the institutional electronic medical record system and are made available for all MDBC team members to review. All imaging and pathology collected outside MUSC undergo review by the MDBC’s radiologist and pathologist before the meeting of the tumor board. The tumor board moderator, typically the surgical oncologist, presents the patient to the group with a brief summary of the oncologic presentation and pertinent medical history. The MDBC’s radiologist and pathologist present their diagnostic findings. Recommendations for additional diagnostic studies are made and scheduled. Medical, surgical, and radiation oncologists have the opportunity to arrive at a consensus on treatment approaches before speaking with the patients, during consultation visits, which are held on the same day, in one location. Patients are screened for clinical trial eligibility and the need for genetic counseling, based on the National Comprehensive Cancer Network guidelines. If there are known barriers to compliance with care, the patient navigators are scheduled to meet with the patient during their MDBC visit. The tumor board also is a forum for the coordination of care as patients transition from one treatment modality to the next. For example, the MDBC team members review the pathologic findings for patients having recently completed surgery and make recommendations for adjuvant treatments based on those findings. The nurse navigators document the care plan decisions and the patient’s cancer stage in the electronic medical record. The nurse navigators ensure the patients are scheduled with the appropriate MDBC team members based on the tumor board’s recommended treatment plan. Patient consultations with the MBDC team begin immediately following tumor board. Patients are stationed in an examination room and all scheduled providers rotate in and out of each patient’s room. Patients have the opportunity to express their goals and desires for their treatment during the consultation, and because of the physical proximity of the care team, this information is immediately conveyed to all members. To assess progress in improving the delivery of cancer care through the MDBC model, a 14-question postconsultation telephone survey was developed to evaluate patient satisfaction with multiple aspects of their clinic experience. This study aimed to examine satisfaction with the MDBC model; identify any potential differences in satisfaction across age groups; cancer stages; or race; and to inform the future refinement of the MDBC program.