Intervention to improve patient self-management and satisfaction in breast and lung cancers using the 4R Oncology model: Results by cancer, race and deprivation index.

Abstract

326 Background: Patient self-management (pSM) is important for optimal cancer care, health equity and mitigation of clinician shortage (Howell 2021, Alfano 2022). 4R Oncology is an intervention fostering pSM and team-based care with a novel Care Sequence plan. 4R (Right Info / Care / Patient / Time) has been shown to improve pSM in breast cancer (Trosman 2021) but has not been studied for impact in other cancers or whether impact is affected by race or neighborhood deprivation index (NDI). 4R effect on patient satisfaction with care – important in care quality and reimbursement – is also unknown. We examined 4R impact on pSM and satisfaction in lung and breast cancers and whether it was influenced by race and NDI. Study took place at 3 centers of a large health system Oct 2020 - Dec 2021. Methods: Surveys of patient: 4R cohort who received 4R plans (N=192) and historical control who received care pre-4R (N=103). Cohorts included breast cancer stages 0-3 and all lung cancer stages. Results: Survey response: 53% (control), 42% (4R). 4R significantly improved 4 of 5 pSM metrics from control to 4R cohort in each cancer (table). Satisfaction with care improved in 3 of 5 metrics in lung and 2 metrics in breast cancer. pSM significantly improved in all metrics from control to 4R cohort for non-White patients, and in 2 of 5 metrics for White non-Hispanics. Satisfaction significantly increased in 3 metrics in both race groups. NDI did not affect 4R impact: both higher and lower NDI groups benefited similarly in all metrics from control to 4R cohorts (data not shown). Conclusions: 4R is effective in improving patient self-management and satisfaction with care across different cancers. Non-White patients derived more self-management benefit than White non-Hispanic, indicating that 4R may help address racial disparities. Deprivation index results suggest that 4R benefits both lower and higher socioeconomic status patients. Further model refinement should address remaining gaps along relevant metrics.[Table: see text]