RESUMO
INTRODUCTION: The present study examined the feasibility and effects of integrating a multidisciplinary team (MDT) model of care for women with metastatic breast cancer (MBC) into a large Australian cancer center. The challenges encountered and lessons learned are described. PATIENTS AND METHODS: In the present prospective, longitudinal, mixed-methods implementation study, the MDT model included face-to-face consultations with a breast care nurse and social worker, followed by a MDT case discussion and face-to-face delivery of a personalized management plan. Data were collected to describe the cohort of women living with MBC who had attended a specialist breast cancer service and their supportive care needs. RESULTS: A total of 62 women with median age of 60 years (interquartile range [IQR], 37-82 years) participated. The median interval from the first breast cancer diagnosis was 5.7 years (IQR, 2.0-11.6 years), and the median interval from the diagnosis of MBC was 2.0 years (IQR, 0.9-3.6 years). The MDT care model required new resources and cross-sector participation. However, the participants indicated a preference for personalized needs assessment and care planning at the diagnosis of MBC. CONCLUSIONS: The results highlight the challenges of implementing and evaluating an MDT care model for women with MBC. The model coordinated MDT collaboration to strengthen the delivery of complex care plans. Investment in cross-sector partnerships to optimize care coordination for women with MBC was needed.
Assuntos
Neoplasias da Mama/enfermagem , Neoplasias da Mama/secundário , Atenção à Saúde/métodos , Modelos de Enfermagem , Equipe de Assistência ao Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Neoplasias da Mama/epidemiologia , Institutos de Câncer , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Estudos Longitudinais , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Medidas de Resultados Relatados pelo Paciente , Estudos ProspectivosRESUMO
A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients' input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.