Multidisciplinary Cancer Care Team Research Articles

Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center.

Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties. As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center. Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported. Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development. Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction. Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Review of recent advances in managing periocular skin malignancies.

Management of cutaneous malignancies can be particularly challenging when they are located in the periocular region. The standard of care for localized disease is complete surgical excision, but this may not be possible without significant disruption to visual structures and facial appearance. Definitive radiation may be an option for some patients who cannot or do not wish to undergo surgery. Advances in systemic treatment options for locally advanced and metastatic skin cancers in the past 10 years have prompted investigation into neoadjuvant treatment of periocular cancers. The use of chemotherapy, immune checkpoint inhibitors, and targeted therapies have all been reported with varying degrees of success. For many patients, targeted therapies or immune checkpoint inhibitors should be considered depending on the cancer type, symptoms, and goals with the input of a multidisciplinary cancer care team. In this article, we systematically review the latest updates in surgical, radiotherapeutic, and medical management of periocular malignancies.

Enhanced Communication of Tumor Margins Using 3D Scanning and Mapping.

After oncologic resection of malignant tumors, specimens are sent to pathology for processing to determine the surgical margin status. These results are communicated in the form of a written pathology report. The current standard-of-care pathology report provides a written description of the specimen and the sites of margin sampling without any visual representation of the resected tissue. The specimen itself is typically destroyed during sectioning and analysis. This often leads to challenging communication between pathologists and surgeons when the final pathology report is confirmed. Furthermore, surgeons and pathologists are the only members of the multidisciplinary cancer care team to visualize the resected cancer specimen. We have developed a 3D scanning and specimen mapping protocol to address this unmet need. Computer-aided design (CAD) software is used to annotate the virtual specimen clearly showing sites of inking and margin sampling. This map can be utilized by various members of the multidisciplinary cancer care team.

A Case of Metastatic Renal Cell Carcinoma to the Maxillary Sinus Initially Presenting as Recurrent Epistaxis

Abstract Metastatic neoplasms to the sinonasal tract are rare. Here, we report the case of a 74-year-old woman with no notable oncological history, presenting to the emergency department with a 3-week history of intermittent epistaxis. CT and MRI revealed a right-sided sinonasal tract mass with histopathological analysis revealing cells of clear cell renal cell carcinoma origin. Full-body CT revealed a 4.9-cm L renal mass for which cytoreductive nephrectomy was performed after immunotherapy. The patient experienced recurrence of the sinonasal mass 14 months from initial discovery, for which they continue to follow with our multidisciplinary cancer care team.

Facts and Hopes in Neoadjuvant Immunotherapy: Current Approvals and Emerging Evidence.

In 2021 and 2022, two immune checkpoint inhibitors received FDA approval in the neoadjuvant setting for the treatment of early-stage triple negative breast cancer (TNBC) and non-small cell lung cancer (NSCLC). Several more studies have since indicated the benefits, and challenges, of administering neoadjuvant immunotherapy prior to definitive surgery in the gastrointestinal, head and neck, and cutaneous realms. In addition, numerous ongoing phase II and phase III trials are investigating outcomes of neoadjuvant immune treatment in early-stage disease. As such, it is anticipated that more immune checkpoint inhibitors will receive approval for various neoadjuvant indications in the next several years. Medical oncologists, surgeons, and other providers in a multidisciplinary cancer care team will be presented with alternate treatment paradigms and clinical decisions regarding upfront surgery versus neoadjuvant treatment. Here, we describe the current evidence supporting use of immune checkpoint inhibitors for neoadjuvant treatment, ongoing studies, and clinical considerations of this treatment approach.

Virtual 3D Specimen Mapping in Head & Neck Oncologic Surgery.

Virtual 3D specimen mapping of oncologic surgical specimens provides a visual record of the specimen and margin sampling sites which can be utilized in a variety of cancer care settings. Our objective was to perform a retrospective review of head and neck surgical oncology cases where the specimen was mapped post-operatively and to evaluate the utility of these 3D specimen maps amongst the multidisciplinary cancer care team. A retrospective review of our 3D specimen model biorepository was performed. Surgical specimens were 3D scanned and then graphically annotated (or "mapped") during routine pathologic processing. The resulting 3D specimen maps were distributed to the multidisciplinary oncologic care team. Final margin status and any use of the 3D specimen maps were recorded. A total of 28 cases were included. Virtual 3D specimen maps were utilized by the cancer care team in 8 cases (29%), including 2 positive margin cases, 2 close margin cases, and 4 indeterminate margin cases. 3D specimen maps were used to visualize positive margin sites for pathologist-surgeon communication as a visual reference during tumor board discussions and to inform radiation treatment planning. Post-operative virtual 3D specimen mapping of oncologic specimens creates a permanent visual record of the specimen and the margins sampled and may serve as a beneficial tool for communication amongst the multidisciplinary cancer care team. 4 Laryngoscope, 134:191-197, 2024.

Improving guideline-concordant biomarker testing through implementation of a precision cancer medicine steward.

e18706 Background: Gaps in guideline-concordant cancer biomarker testing exist in real-world clinical practice. Medically underserved populations, in particular, face significant challenges to accessing the latest advances in cancer diagnostics. As community cancer programs work to expand their approach to precision medicine, some have created a precision medicine “steward” who acts as a point person for removing barriers to biomarker testing. The Association of Community Cancer Centers (ACCC) explored the clinical utility, impact, and feasibility of having a precision medicine steward on the multidisciplinary cancer care team. Methods: ACCC held a series of focus groups and interviews with a diverse group of stakeholders to explore how cancer programs had justified, hired, trained, and utilized precision medicine stewards to improve guideline-concordant biomarker testing rates. ACCC examined select job descriptions, learned how stewards helped improve biomarker testing processes, and developed a framework for how a steward can fit into cancer care teams’ clinical and operational workflows. Results: Precision cancer medicine stewards can help improve biomarker test ordering processes. In one member program, turnaround time from test ordering to receipt of results decreased from an average of 24 days to 12 days and the quantity non-sufficient rate of testing decreased by five percent. Stewards also helped to improve the digitization of test orders, streamline prior authorizations, track tissue specimens, and notify oncologists when quantity of tissue was not adequate for testing. Stewards contributed to precision medicine workgroups that vetted reference laboratories, tracked key performance indicators around biomarker testing, and prioritized opportunities to reduce testing disparities. ACCC also collated examples of job titles, job descriptions, and role responsibilities of precision medicine stewards to share across member programs and practices. Conclusions: Guideline-concordant biomarker testing requires multiple complex steps and careful care coordination. Precision cancer medicine stewards have been shown to improve testing-related processes, decrease the time from ordering to receipt of results, and assist with prior authorizations. ACCC will work to further highlight their contributions on the multidisciplinary cancer care team and document more evidence of their return on investment for cancer programs and practices.

Best practices study to enhance the quality of multi-disciplinary teams in lung cancer care.

1532 Background: Regular meetings at multi-disciplinary teams (MDTs) constitute a key moment in the care pathway in lung cancer, where physicians collectively discuss patient cases and decide on treatment plans. MDTs arguably increase the volume of patients treated, improve diagnosis, and positively impact on survival. However, the way MDTs are organized and function is variable across hospitals, countries and continents. Variations in MDT processes may lead to sub-optimal outcomes, such as inconsistencies on the numbers of patients treated with curative intent as well as variable 5-years survival rates for lung cancer. The importance of MDTs is ever increasing, as the therapeutical landscape is getting more complex every year, and treatments are evolving from a one-size-fits-all to a personalized approach. Methods: In this study, we gather the best practices in MDT processes, capabilities and governance in 24 leading hospitals throughout Europe and Canada. We map the MDT practices of each hospital into a coherent framework, and identify KPIs and best practices by conducting semi-structured interviews with health care professionals in each hospital and performing workshops with the entire MDT team. The primary research focuses on five key categories: access to the MDT, processes, technology (such as EMR, data sharing tools, and artificial intelligence), culture and capabilities. Results: We see a high variation in the way MDTs are organized, in time for discussion per patient, in the model of care and current MDT practices across the 24 hospitals in this project, along our five identified categories. We developed an MDT maturity model where we score individual elements within these five categories to identify the hospitals with the best MDT practices, and a total of 23 key success factors along the MDT process. The maturity model and the key success factors can be used as a self-assessment tool for MDT-teams for continuous quality improvement. Conclusions: MDTs have the potential to be a standard part of the patient care pathway, where excellence is consistently achieved when discussing patient cases. This work has identified the practices that are done best in leading hospitals and that have the potential to be progressively adopted. Furthermore, we see that the potential of decision support tools and other artificial intelligence is rarely leveraged by MDTs.

Oncology financial advocacy services guidelines: Results of a Delphi study.

e18606 Background: At least half of people with cancer experience financial toxicity1 but financial advocacy has emerged as a promising intervention to mitigate it. How cancer programs and practices screen for financial toxicity among patients and the types of services they offer vary greatly. Standardization is needed to evaluate the outcomes and impacts of financial advocacy. Therefore, the Association of Community Cancer Centers (ACCC) Financial Advocacy Network set out to develop Oncology Financial Advocacy Services Guidelines (hereafter “the Guidelines”) to address this gap. Methods: To conduct this original, non-clinical trial research, ACCC convened a task force of seven multidisciplinary experts in financial advocacy to oversee a modified Delphi study. The task force assembled a panel of 49 experts, who represented oncology financial advocacy staff, multidisciplinary cancer care team members, financial advocacy subject matter experts, as well as patients and patient advocates. Based on a literature review and qualitative input from panelists, the task force drafted a list of 44 potential guidelines. In early 2022, panelists completed two rounds of anonymous voting, determining if each statement should not be a guideline, be a minimum guideline, or be an enhanced guideline. Consensus was set at 75% agreement. Results: The panel reached consensus that 43 statements should be guidelines. One guideline was rated minimum, while another 17 trended toward being considered minimum (60%-74% agreement among panelists). The panel rated one guideline as enhanced, with two others trending toward being enhanced. Twenty-two guidelines did not reach consensus one way or another on being minimal vs. enhanced. Conclusions: The Guidelines are publicly available in a report that includes implementation considerations extracted from Delphi panelists’ comments and task force input. Half of guidelines did not reach consensus on whether they are minimum or enhanced, reflecting the diversity of current financial advocacy practice and a need to develop greater standardization in the field. ACCC is taking several next steps to advance research and quality practice using the Guidelines, including collaborative policy development, assessment tools, and the creation of valid metrics and accountability measures.

An evaluation of current practice patterns for patients with renal cell carcinoma.

655 Background: First-line immunotherapy and tyrosine kinase inhibitor (TKI) treatment combinations have significantly improved clinical outcomes for patients with renal cell carcinoma (RCC). To maximize clinical benefit of these regimens, risk stratification should guide treatment selection and treatment-related adverse events (AEs) should be appropriately managed. The goal of this project was to identify current practice patterns regarding treatment selection, guideline-based management of AEs, care coordination, and patient education for individuals with RCC treated in community oncology programs and practices. Methods: In July-September 2022, ACCC administered an online survey to evaluate current practice patterns for patients with RCC treated in community cancer programs. To maximize participant engagement, the survey was also shared with advanced practitioner, pharmacist, and oncology nurse members of the Advanced Practitioner Society for Hematology and Oncology (APSHO) and the Kidney Cancer Association who provide care to patients with RCC. Results: Respondents (n=104) were mainly surveyed from community cancer care programs or private/physician practices (69%) in urban/suburban settings (90%) who average 25-75 patients with RCC annually (77%). Most respondents (89%) reported using a combination of an immunotherapeutic and a TKI as initial treatment for advanced clear cell RCC while only 61% of respondents reported frequently using risk scores for newly diagnosed patients. 45% of regimen-specific patient education happens as a separate visit, usually conducted by the oncologist (23%) or the infusion nurse (22%), and 37% of respondents conduct this education on the first day of treatment. The responsibility of providing comprehensive patient education seems to vary by program with the oncologist being the most reported (23%), followed by infusion nurse (22%), clinic nurse (20%), advanced practice provider (18%), and pharmacist (16%). The frequency of monitoring AEs differed based on the given regimen. Respondents mainly (54%) monitored on day 1 of the cycle and again mid-cycle in patients receiving immunotherapy, while 40% monitor only on day 1 of the cycle in patients receiving single-agent TKIs. Clinic nurses are primarily responsible (40%) for monitoring treatment adherence in patients receiving TKIs and also triage for associated AEs. Conclusions: This survey has identified real-world practice patterns related to the management and monitoring of patients with RCC prescribed immunotherapy and tyrosine kinase inhibitor combinations. Opportunities exist to increase utilization of risk assessments, create patient education materials for the multidisciplinary cancer care team, and address the optimal frequency of adverse event monitoring.

Enhancing Coordination Around Cancer Biomarker and Hereditary Genetic Testing Among Members of the Multidisciplinary Care Team

Abstract Introduction/Objective Advances in precision medicine necessitate a closer integration across pathologists, genetic counselors, and other members of the multidisciplinary cancer care team (MDT). Recognizing that physical distancing and fragmented communication may hinder care delivery, the Association of Community Cancer Centers (ACCC) ran a multi-year initiative to explore ways to improve MDT care coordination. Methods/Case Report ACCC held a multistakeholder leadership summit to identify and discuss critical issues regarding biomarker and hereditary genetic testing and the ways in which pathology and genetic counseling professionals interface with the cancer MDT. Through a consensus-driven process, participants identified key opportunities for achieving optimal integration. ACCC also conducted a national survey to explore barriers around biomarker and hereditary genetic testing. Building off these insights, ACCC conducted virtual workshops at three community cancer programs to improve processes around biomarker testing and targeted treatment planning. Results (if a Case Study enter NA) The pathology leadership summit identified the following priorities: 1) streamline and standardize the biomarker test ordering process; 2) improve tissue handling to optimize timely biomarker testing; 3) strengthen communication between pathologists and genetic counselors; 4) empower pathologists with leadership opportunities. In the ACCC survey (n=659), 57% indicated that some or most of their pathologists were generalists. 21% only held one general tumor board. 6% indicated that pathologists often do not attend tumor boards or cancer committee meetings. 64% indicated that pathologists can directly access some or all medical oncology patient records. 67% sent some or most biopsy samples out for biomarker testing. In the ACCC workshops, cancer programs in KS, NC, and NV identified ways to improve the timeliness of genetic counseling referrals and coordinate biomarker testing. Following the workshops, 64% indicated they planned to make moderate or significant changes in their processes. Conclusion Improving collaboration across pathologists, genetic counselors, and the rest of the cancer MDT may lead to more timely and comprehensive biomarker and hereditary genetic testing. These findings may help cancer programs refine processes of care.

Reducing preventable ED visits in patients with advanced NSCLC: Collective insights from three cancer centers.

337 Background: While many patients with advanced NSCLC have complex medical needs, emergency department (ED) visits may be preventable if clinicians predict, identify and treat symptoms early and deliver outpatient interventions. The Association of Community Cancer Centers (ACCC) evaluated how cancer centers participating in a multi-phase initiative found ways to reduce preventable ED visits in patients with advanced NSCLC. Methods: After holding QI workshops, ACCC followed-up with three centers located in AL, OK, and OH. These centers aimed to improve lung cancer symptom management, patient education, and care coordination related to the CMS Measure #OP-35 diagnoses: dehydration, diarrhea, emesis, nausea, pain, or pneumonia. Results: Patient Education and Reminders: Patients who undergo systemic treatment often need to be reminded to call their medical oncology team if they develop symptoms. Examples of effective practices include: a patient education and reminder campaign to “call-first” before visiting the ED; wallet cards with phone numbers; and ongoing reminders whenever patients come for infusion or clinician visits. Intensive Care Coordination: Some patients with advanced NSCLC may be “high risk” for ED utilization (eg, co-morbidities, social determinants, etc.). Intensive care coordination delivered by nurses may be directed specifically at these patients. Interventions may include scheduled phone calls and/or telehealth visits to assess symptoms and coordinate outpatient interventions. Immune-related Adverse Events (irAEs): Patients with advanced NSCLC may receive immune checkpoint inhibitors which may cause irAEs. Colitis may lead to dehydration, diarrhea, emesis, nausea; pneumonitis may be misdiagnosed as pneumonia. One center began using a patient symptom questionnaire delivered by a nurse navigator and managed 94% of irAE symptoms in the outpatient setting. Another center surveyed ED providers to assess gaps in identifying irAE symptoms an formed a multidisciplinary irAE work group to discuss patient management and facilitate increased awareness and early recognition. These efforts led to a series of education programs for ED staff. Early Palliative Care: Since early palliative care is associated with reduced ED utilization, one center streamlined palliative care referrals in the outpatient setting by developing an electronic pathway. 91% of patients with advanced cancer enrolled after initial consult; only 24% made an ED visit. Conclusions: While many ED visits are necessary, some may be preventable, especially if members of the multidisciplinary cancer care team risk-stratify patients, proactively identify and empower patients to “call first,” treat symptoms early, and provide early palliative care. The collective insights from these cancer centers provide guidance around sustainable strategies that can potentially reduce preventable ED visits.

Improving Cancer Care Delivery: Learnings for Oncology Nurses and Patient Navigation From a National Quality Survey.

Background:Although implementation of patient navigation programs in clinical practice is widespread, heterogeneity exists in the design and delivery of these services. Greater clarity is required on competencies of personnel, delineation of their roles in multidisciplinary cancer care teams, navigation service components that positively impact patient outcomes, and associated metrics.Methods:A national, double-blind, online survey was implemented between January 24, 2019, and April 25, 2019, to investigate care coordination for advanced (stage III/IV) non–small cell lung cancer (NSCLC). Respondents included multidisciplinary team (MDT) members, such as oncologists, pathologists, oncology nurses, advanced practice nurses, and patient navigators, from US cancer programs. Customized questions covered NSCLC screening, diagnosis, treatment, and care coordination, with a focus on oncology nurses, advanced practice nurses, and patient navigation. Descriptive statistics were computed. Subanalyses examined relationships between care delivery and outcomes such as shared decision-making (SDM) through statistical testing.Results:Across programs, there was a lack of patient (nurse or lay) navigators (22.3%, 101/452) to assist patients with NSCLC. Most respondents (90.1%, 100/111) worked in programs with no formal health literacy assessments. Significantly higher mean SDM scores (p < .05) were observed in programs with patient navigators compared with programs without these specialists.Conclusion:Patient navigation is pivotal to enhancing the patient experience along the lung cancer care continuum and should be strategically integrated within lung cancer MDTs. These findings, along with survey inputs from other MDT disciplines, can help support process improvement plans for patient-centered advanced NSCLC care delivery.

A multiphase continuing education and quality improvement initiative to tailor treatment plans for patients with follicular lymphoma.

e18651 Background: Data support the need for increasing shared decision-making (SDM) conversations to align treatment decisions with patient values and preferences (Kehl KL et al. JAMA Oncol. 2015). Combining certified interprofessional continuing education and quality improvement (QI) methods may accelerate how cancer clinicians translate evidence into real-world clinical practice when diagnosing and treating patients with follicular lymphoma (FL). This initiative was supported by educational grants from Genentech, a member of the Roche Group and Bristol Myers Squibb and managed by AXIS Medical Education and Q Synthesis. Methods: The project collaborators invited three community hospital-based cancer centers to participate in this 18-month longitudinal, multiphase CME/CE and QI initiative. Each cancer center performed a baseline assessment by reviewing how their clinicians diagnosed and treated patients with FL. This process involved chart reviews, focus group discussions, and online surveys. Each cancer center developed problem statements, aim statements, and implemented improvement projects around prognostic scoring, the use of molecular diagnostics, SDM, and treatment planning. Clinicians also participated in two live virtual continuing education interventions, co-moderated by an academic clinician with a focus in lymphoma (T.F.), as well as the medical director of the activity (J.K.) and received reinforcement messages following those activities. Results: Members of the multidisciplinary cancer care team from three cancer centers in AZ, TN, and VA participated in this initiative. Across all three cancer centers, the following educational outcomes were observed: 61% increase in knowledge about the concept of POD24 (early disease progression within 24 months of initiating therapy); 50% increase in knowledge and practice skills regarding tailored treatment planning based on patient risk factors and prognostic scores; 33% increase in knowledge around the benefits of incorporating SDM when developing treatment plans, and an 18% increase in knowledge about risk-based treatment plans. The QI projects resulted in a 56% improvement in prognostic scoring (incorporating tumor grade and stage), a 25% increase in documenting tumor burden, and a 22% increase in the use of molecular diagnostics. Conclusions: This multiphase education and QI program enabled cancer clinicians to improve monitoring patients for POD24 and risk assessment, incorporate molecular testing, engage in SDM conversations with patients, and formulate tailored treatment plans for patients with FL.

Quality Improvement Officers: Key Members of the Multidisciplinary Cancer Care Team

Quality Improvement Officers: Key Members of the Multidisciplinary Cancer Care Team

Investigating a Participatory Intervention in Multidisciplinary Cancer Care Teams Using an Integrative Organizational Model: A Study Protocol.

Multidisciplinary teams encounter many challenges that can lead to higher levels of distress and burnout. This trend is acutely prevalent among multidisciplinary cancer care teams who frequently contend with increased task complexity and numbers of patients. Resilience is emerging as a critical resource that may optimize team members’ psychological health and wellbeing, work efficiency, and organizational agility, while reducing burnout. Accordingly, the proposed study aims to implement and evaluate a promising participatory interventional approach that fosters team resilience. Specifically, the effects of the intervention on participating team members will be compared to a control group of non-participating team members. This intervention’s core components include skills training, patient-centered meetings, talking spaces, and an agile problem-solving approach. The proposed study also seeks to determine whether enhanced resilience improves team mental health status and organizational outcomes. A participatory interventional approach will be implemented and assessed at three-time intervals [i.e., pre-intervention deployment (N = 375), 12 months post-deployment (N = 236), and 24 months post-deployment (N = 146)] across five cancer care teams in three Quebec healthcare institutions. A mixed methods design will be used that includes observations, semi-structured interviews, focus groups, and self-report questionnaires. Direct observation will document team functioning and structural resources (e.g., meetings, conflict management, and leadership). Semi-structured interviews will explore participants’ experience with activities related to the participatory interventional approach, its perceived benefits and potential challenges. Focus groups will explore participants’ perceptions of their team’s resilience and the effectiveness of the intervention. Questionnaires will assess support, recognition, empowerment, organizational justice, individual resilience, psychological safety, work climate, team resilience, workplace burnout, engagement, quality of work life, wellbeing, and organizational citizenship behaviors, and sociodemographic variables. Moreover, objective measures including absenteeism and staff turnover will be obtained via human resource records. Structural equation modeling will be used to test the study’s hypotheses. The proposed protocol and related findings will provide stakeholders with quantitative and qualitative data concerning a participatory interventional approach to optimize team effectiveness. It will also identify critical factors implicated in favorable organizational outcomes in connection with multidisciplinary cancer care teams. Expected results and future directions are also presented herein.

A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study.

BackgroundTumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System.ObjectiveThe first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability.MethodsWe designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool.ResultsWe designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10.ConclusionsThe results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.

Implementation of Standardized Lecture to Improve Radiation Oncology Knowledge in Multidisciplinary Lung Cancer Care Team: Initial Results of a Multi-Institutional Pilot Study

<h3>Purpose/Objective(s)</h3> Most lung cancer (LC) providers have had no exposure to radiation oncology (RO) in training and may not know when a patient should have RO consultation. Despite this, there is paucity of literature describing RO interdisciplinary educational initiatives in LC. In 2019, ASTRO began developing disease-site specific slide decks, the first of which was designed to teach the specialists about RO in management of LC. The deck has been downloaded over 1000 times since it was made public. The authors examined the feasibility of an introductory lecture using the slide deck and its impact on the providers' knowledge and practice. By understanding treatment modalities outside one's own, it is hoped that the providers can present a full spectrum of options needed for patient-centered decision-making. <h3>Materials/Methods</h3> Between November 2019 and May 2021, a total of 7 radiation oncologists offered lectures to attendings and fellows in pulmonology, thoracic surgery, and medical oncology at 8 academic institutions. Due to the pandemic, lectures were given both in-person as well as virtually. The participants were invited to take an anonymized pre-test online, consisting of demographics and 13 multiple choice questions about RO for LC. After the lectures, the attendees were asked to take a post-test identical to the pre-test, with two additional questions about knowledge gained, and comfort level in making appropriate referrals to RO. <h3>Results</h3> A total of 76 individuals completed the pre-test, and 25 completed the post-test. The vast majority of the participants have never had a RO rotation (86%), lecture (75%), or seen a LINAC (82%). The mean pre-test score was 53.5% (SD 17.6%), and the mean post-test score was 75.1% (SD 3.6%), (p<0.001). On the post-test, 12 participants(48.0%) reported feeling much more knowledgeable about the role of RO in LC treatment and 13 (52.0%) felt a little more knowledgeable. A total of 9 participants (36.0%) felt much more comfortable making appropriate referrals to RO after the lecture, whereas 15 (60.0%) felt a little more comfortable, and 1 (4.0%) felt not any more comfortable. The improvement in score and reported knowledge and comfort levels were similarly observed across all subspecialties and between attendings and fellows. <h3>Conclusion</h3> Introductory lecture on RO for LC given using a standard slide deck resulted in a statistically significant improvement in relevant knowledge of RO. Nearly all participants also reported improved comfort level in making appropriate referrals to RO. The current study demonstrates feasibility of implementing such lectures to multiple providers across various institutions even during a pandemic. An organized effort to provide such lectures at more institutions may result in more appropriate management and RO referral for LC patients, especially in practice settings where tumor board is not readily available.

The integral role of nurses' knowledge in the multidisciplinary cancer care team for patients' safety and life stability

The number of cancer patients is increasing where oncology nurses must evolve in the treatment and modality of therapies. Nurses must play a crucial role in the management of cancer population to make sure that nurses working in this field are knowledgeable enough to work with cancer patients. Thus, the aim of this study is to evaluate the nurses' knowledge in multidisciplinary cancer care team and improve the nursing practices through education and conferences. Therefore, it is important to describe the nurses' attitudes and practices at Clemenceau Medical Center because nurses should guide and empower patients through their treatment journey by specifying the patients' needs and developing an individualised plan of care. Therefore, the analysis of the study has shown that nurses are unaware of the risks associated when assessment, education and counselling are insufficient. Nurses should believe that planning and education will improve the quality of life for patients.

The integral role of nurses knowledge in the multidisciplinary cancer care team for patients safety and life stability

The integral role of nurses knowledge in the multidisciplinary cancer care team for patients safety and life stability