Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions

Abstract

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system. METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. RESULTS: We formed an internally and externally recognized team of 24 specialties committed to a shared goal of delivering multidisciplinary care at the optimal time and sequence from a patient-centric viewpoint. The team conducted 40 optimizations of interdependent care (22 for breast, seven for lung, and 11 for both cancers) at four points in the care continuum and established an ongoing teamwork adaptation process. Half of the optimizations entailed low effort, while 30% required high level of effort; 78% resulted in improved process efficiency. CONCLUSION: 4R facilitated development of a large high-functioning team and enabled 40 optimizations of interdependent care along the cancer care continuum in a feasible way. 4R may be an effective approach for fostering high-functioning teams, which could contribute to improving viability of the oncology workforce. Our intervention and taxonomy of results serve as a blueprint for other institutions motivated to strengthen teamwork to improve patient-centered care.

Understanding Barriers and Facilitators to High-Quality Cancer Care Among Veterans With Lung Cancer: A Qualitative Study

“…Formalized team-based care models, as shown in other settings, are promising approaches that can address the grave impact of fragmented care. 21,22 Our study findings also highlight the complex relationship between extensive travel, financial hardship, and emotional, mental, and physical health. In the United States, most Veterans live in rural areas with disproportionately higher rates of chronic mental and physical health conditions compared with nonrural ones.…”

“…Formalized team-based care models, as shown in other settings, are promising approaches that can address the grave impact of fragmented care. 21,22…”

Time is of the Essence: Why Goals-of-Care Conversations and Prognosis Documentation Matters in Advanced Cancer Patients in an Integrated Health System

“…The 4R Oncology Model (implemented after this study period) is a team-based care-delivery model shown to foster high functioning multidisciplinary teams, with surgery and oncology as the leader in goal-directed care. 38 Our institution has previously demonstrated the use of this coordinate care is associated with increased advanced directives completion, 39 but other areas of advanced care planning, such as goals of care documentation by an oncologist, yet to be explored. Additionally, we expect improvement with increased training with a standardized, well-crafted, easily implementable goals-of-care template incorporated into the electronic medical record.…”

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

“…A team-based care approach may be 1 strategy to ensure cancer survivors receive optimal care, given the burden placed on PCPs to deal with a variety of issues with their patients. 30,31 Although PCPs may need to recognize and screen for specific conditions, a team-based approach can help with optimally treating patients by referring them to other health care professionals on the team, including team members with specialized training on specific topic areas. For example, a PCP could assess for psychosocial distress using a standardized tool, and then refer patients to an appropriate mental health professional, similar to the practice in many oncology settings.…”