Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: National Comprehensive Cancer Network (NCCN) Guidelines recommend initiating postoperative radiation therapy (PORT) within 6 weeks of surgery for patients with head and neck squamous cell carcinoma (HNSCC), but delays affect >50% of patients and contribute to worse oncologic outcomes. Delivery of timely PORT to patients with HNSCC requires patient-centered coordination of a multi-team system (i.e., interdependent team-of-teams approach) of clinicians from different medical specialties working together towards the common goal of timely PORT initiation. Excellence in communication and care coordination are critical to a highly functioning multi-team system and potentially modifiable targets to enhance delivery of timely PORT.
Objectives: To characterize care coordination and communication related to initiation of timely PORT among HN oncology clinicians and evaluate factors associated with variability in each.
Study Design: Baseline data from within a multi-site randomized clinical trial.
Setting: 4 US academic medical centers.
Participants: HN surgical, radiation, and medical oncology attending physicians, advanced practice providers (APPs), nurses, and navigators.
Main Outcomes and Measures: Care coordination was measured with the Continuity of Care Practices Survey-Individual (CCPS-I) Coordinate Care Subscale, a validated measure of multidisciplinary clinical care coordination modified for timely PORT. Scores range from 6 to 20; higher scores represent more coordinated team care but established threshold values for high quality coordination are not defined. Communication was assessed with the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) Communication Subscale, a validated measure of inter-team communication in healthcare modified for timely PORT. Scores range from 15 to 30; higher scores represent better teamwork but established threshold values for high quality communication are not defined. Linear regression models were created to identify factors associated with CCPS-I Coordination Care and T-TAQ Communication scores.
Results: Of the 41 oncology team members included in the study, the median age was 41 years (IQR 38-46); 63.4% of provider were male and 65.9% were White. Most were members of the HN surgical oncology team (53.7%), followed by radiation oncology (31.7%) and medical oncology (14.6%). The mean CCPS-I Coordinate Care Subscale score was 13.9 (SD 3.5). The mean T-TAQ Communication Subscale was 21.5 (SD 3.1). Care coordination for timely PORT as measured by CCPS-I Coordinate Subscale scores varied by institution/practice site (p=0.001). Communication for timely PORT as measured by T-TAQ Communication Subscale scores varied by practice provider type (p=0.047). APPs had higher T-TAQ Communication Subscale scores relative to physicians on multivariable linear regression analysis (T-TAQ Communication Subscale score β=3.51, 95% CI 0.76 to 6.26).
Conclusions: In this multicenter study, we identified that care coordination scores varied across institutions and communication scores varied across provider type. Further research is needed to understand heterogeneity with regards to care coordination and communication, develop strategies to enhance both, and improve performance of the multi-team system to improve the delivery of timely, guideline-adherent PORT.