My team’s current project to understand communication in ambulatory oncology settings stems from more than a decade of research, in which we have tried to uncover the factors that facilitate high-quality cancer care for patients and a satisfying practice environment for care teams.
The project involved 29 diverse medical oncology practices, and we used mixed methods study design, including patient and clinician surveys, selected site visits, observations, interviews, and focus groups, to obtain a rich description of the state of ambulatory oncology care. More than 300 clinicians and 2,200 patients participated in the study, which was funded by the Agency for Healthcare Research and Quality.
We documented the correlation between communication and safety for patients and nurses and the pervasive safety challenges in ambulatory oncology environments. We found that, with growing patient volumes, less slack in the system, leaner staffing, and physical plant challenges, cancer care teams rarely have the time and space to connect and review patients’ care plans. The result is a lot of “stop-and-go” for patients:
Time spent clarifying discrepant antineoplastic orders
Challenges with escalating concerns when a patient experiences treatment-related toxicity
Mixed messages about treatment plans between patients and the cancer care team
Consequences included delayed treatment, overcrowded infusion spaces, and unnecessary emergency department use, but we also identified actionable strategies to improve teamwork and communication:
Reduce the distance between infusion settings and medical oncology clinics.
Establish clear lines of communication.
Institute agreements about response times when a team member expresses concerns.
Couple proactive patient-reported toxicity monitoring with evidence-based supportive care.
Cancer care team leaders must take the time and space to periodically convene with the group, evaluate progress and challenges, and recommit to shared work principles on how to communicate and respond to concerns.
We’re particularly excited about two new communication projects. The first is a National Cancer Institute-sponsored interdisciplinary training program for nurses and pharmacists to improve chemotherapy safety. Preliminary evidence suggested that our approach, which combines self-learning, group discussion, and simulation activities, improved knowledge and confidence to deliver chemotherapy safely, and more than 60% of participants have applied the knowledge to make positive changes at their institutions.
Second, in March 2021, we launched an intervention study to strengthen teamwork and communication in ambulatory oncology. We are assessing feasibility, acceptability, and preliminary efficacy now and pursuing funding for a larger confirmatory study.
Regardless of clinical setting, high-quality communication across all members of the cancer care team, including patients and their loved ones, is an essential ingredient to safe care.