Leveraging a Team Mental Model to Develop a Cancer Anorexia-Cachexia Syndrome Team

Abstract

This article discusses the care of a 62-year-old man with non-small-cell lung cancer and associated cancer anorexia-cachexia syndrome (CACS), and demonstrates common challenges faced by such patients and their family caregivers. The case description illustrates the fragmented approach of various disciplines to the patient's CACS care, resulting in undertreatment, delayed and burdensome visits, and patient and caregiver frustration and emotional distress. The mounting problems that arise for the patient over time exemplify the absence of a shared mental model among the various providers, patient, and caregiver for the care of CACS. Shared knowledge among providers regarding the tasks to be performed, the other clinicians' functions, and optimal processes for CACS care was limited. Each provider was responsive to individual symptoms, rather than conceptualizing the constellation of symptoms as a syndrome that warrants coordinated care among clinicians. This resulted in the patient and the family caregiver being at odds with their various providers instead of working in partnership with a shared understanding toward common goals. Team mental models have the potential to enhance development and implementation of care plans and improve patient care and satisfaction by helping clinical care teams establish team membership, identify shared tasks, and facilitate interactions. To help inform ongoing clinical practice and research, this article demonstrates how clinicians at one cancer center are leveraging a team mental model to form and support an interdisciplinary CACS team that provides coordinated patient-centered care.

The Psychosocial Components of Multimodal Interventions Offered to People with Cancer Cachexia: A Scoping Review

“…This review found 19 publications[ 16 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 ] reporting a multimodal intervention for cancer cachexia with a psychosocial component and published from January 2013 to March 2021. They included complex interventions used in practice ( n = 3),[ 27 28 38 ] tested in the context of a feasibility study ( n = 6)[ 16 24 29 32 36 40 ] or pilot/early phase trial ( n = 5),[ 23 24 31 33 39 ] and theorized approaches drawing on existing literature and expert opinion ( n = 6). [ 25 26 30 34 35 37 ] The interventions tested were found to be feasible and safe (when adverse events and safety issues were reported [ n = 8]).…”

Clinical Oncology Society of Australia: Position statement on cancer‐related malnutrition and sarcopenia

“…3,25 Frameworks, such as the team mental model, have been found to optimise team processes and functioning. 54 Multidisciplinary cancer prehabilitation and rehabilitation programs providing individualised care demonstrate capacity to improve nutritional status, muscle mass and strength, fatigue and performance status. [55][56][57][58] These interventions require the specialist skills of various MDT members as part of a coordinated approach to individualised treatment of cancer-related malnutrition and sarcopenia and can be accessed through acute hospital services, community-based services or general practices.…”

“…Alongside medical nutrition therapy, interventions that have been shown to contribute to optimising nutritional status and body composition include exercise, management of treatment side effects through optimising medications and the management of anorexia and dysphagia 3,25 . Frameworks, such as the team mental model, have been found to optimise team processes and functioning 54 . Multidisciplinary cancer prehabilitation and rehabilitation programs providing individualised care demonstrate capacity to improve nutritional status, muscle mass and strength, fatigue and performance status 55‐58 .…”

Clinical Framework for Quality Improvement of Cancer Cachexia

“…[ 22 ] Cancer cachexia is a complex syndrome and the goal of the treatment is to fix the various broken pieces using an interdisciplinary team approach. [ 6 23 ]…”

“…[ 1 ] Team approaches and holistic care to the management of cancer cachexia have been proposed as a model of improving patient care and outcomes. [ 6 7 8 9 ]…”