Results Summary
What was the research about?
Patients with lung cancer get care from many kinds of doctors. These doctors specialize in different treatments, such as radiation or surgery. Patients often receive one treatment after another. However, their doctors may not talk to each other about the care a patient receives.
In this study, the research team compared health records and survey responses from patients with lung cancer who received treatment in one of three ways:
- Multidisciplinary care planning. Patients in this group received care in a new clinic that has doctors and nurses with different specialties. All the doctors worked together and with the patients to plan their treatment. A nurse helped arrange the care.
- Serial care. Patients in this group received usual care for patients with lung cancer. They saw each doctor as needed, without help to coordinate the care.
- Serial care plus team discussion. Like patients in the serial care group, these patients saw their doctors as needed. But the patient’s main cancer doctor talked about the patient’s care plan at a weekly meeting with other types of doctors. This team of doctors helped decide on a care plan.
The research team wanted to learn if multidisciplinary care planning would help patients with lung cancer live longer or have better quality of life compared with the other two approaches. The team also compared patients’ care with guidelines for how doctors should treat lung cancer.
What were the results?
People lived for about the same length of time in all three approaches.
Compared with patients in the serial care approach, patients in the multidisciplinary care planning and serial care plus team discussion approaches had better quality of care. There was no difference in the quality of care between patients in those two approaches.
Patients and caregivers in the multidisciplinary care planning approach were more satisfied with their care than patients in either serial care approach.
Who was in the study?
The study included 526 patients with lung cancer in the greater Memphis, Tennessee, area. Of these, 68 percent were white, 31 percent were black, and 1 percent were other races. The patients’ average age was 67, and 51 percent were men.
What did the research team do?
Doctors assigned patients to one of three approaches. Patients were in the multidisciplinary care planning approach if their doctors referred them to the new clinic. Those without referrals or who had already started treatment were in the two serial care approaches.
Patients and caregivers completed surveys at the start of the study and three and six months after treatment started. The survey asked patients and their caregivers about satisfaction with the care they received. The research team looked at patients’ health records for up to 18 months after the study started. From the records, they found out what treatments each patient had received and whether they had died.
The research team worked with patients, caregivers, and doctors to create the survey questions and decide what information to collect.
What were the limits of the study?
The research team didn’t assign patients to each approach by chance. The team can’t be sure that the results were due to the multidisciplinary clinic and team discussion or something else.
Future studies could assign patients to approaches by chance. Research might also look at the effect of including patients and caregivers in the team discussion.
How can people use the results?
Lung cancer care clinics can use these results when considering how to improve quality of care and patient satisfaction.
Professional Abstract
Objective
To compare survival, quality of care, and quality of life outcomes of three care delivery approaches for patients with lung cancer
Study Design
| Design Elements | Description |
|---|---|
| Design | Observational: cohort study |
| Population | 526 patients recently diagnosed with lung cancer |
| Interventions/ Comparators |
|
| Outcomes |
Primary: overall and event-free survival Secondary: quality of care, as measured by thoroughness of staging, stage-appropriate treatment rates, concordance rates between consensus recommendations and delivered care, and timeliness of care; patient- and caregiver-reported satisfaction |
| Timeframe | Up to 18-month follow-up for primary outcomes |
This study evaluated the effect of multidisciplinary care planning on survival rate, quality of care, and patient and caregiver satisfaction using a newly formed multidisciplinary clinic (MDC) within a community-based, nonacademic healthcare system in the greater Memphis, Tennessee, area. Researchers compared three cohorts:
- MDC. Providers referred patients to the MDC to finalize a treatment plan for their cancer in consultation with a multidisciplinary team of clinicians. The team included a thoracic surgeon, medical oncologist, radiologist, pulmonologist, and radiation oncologist. Team discussions about the treatment plan included patients and their caregivers. A dedicated nurse navigator coordinated care for the patient according to the treatment plan finalized in the MDC.
- Standard serial care. Patients in the same healthcare system who were not referred to the MDC or who had already begun treatment could join this cohort. These patients received usual care that included a treating oncologist and serial referral to other specialists as needed.
- Serial care with Multidisciplinary Thoracic Oncology Conference (MTOC). Based on referral from their treating physician, a smaller number of patients in the serial care group had their cases discussed in the MTOC. The MTOC, a broad group of clinicians, nurses, and specialists, offered input on the patient’s treatment plan, but the patients or caregivers were not present.
Researchers enrolled 178 patients in the MDC and 348 in serial care; providers referred 76 of these 348 patients to the MTOC, and the remaining 272 received standard serial care. Among all patients, 68% were white, 31% were black, and 1% were other races. The patients’ average age was 67, and 51% were male.
For up to 18 months after patient enrollment, researchers reviewed electronic health records for outcomes, including survival and quality of care. The National Comprehensive Cancer Network guidelines informed the evaluation of stage-appropriate quality of care. Patients and their caregivers completed surveys measuring satisfaction at baseline and three and six months after starting treatment.
Patients, caregivers, clinicians, oncology specialists, and administrators oversaw the development of the MDC and the study design and implementation.
Results
Survival. The study found no differences in overall or event-free survival among patients in the three cohorts.
Quality of care. Overall, patients in the MDC and serial care with MTOC cohorts had better quality of care than those in the standard serial care cohort (p<0.05) in all measures of quality except the timeliness of care. Patients in the MDC and MTOC cohorts had similar quality of care.
Patient and caregiver satisfaction. Patients and caregivers in the MDC cohort were more satisfied with their overall care compared with those in the standard serial care cohort at six months (p<0.0001) but not with timeliness of care.
Limitations
Providers decided which patients would be in the MDC cohort, which may have biased the findings.
Conclusions and Relevance
The use of multidisciplinary care planning for patients newly diagnosed with lung cancer resulted in better overall quality of care and patient and caregiver satisfaction but did not affect survival rates at 18 months.
Future Research Needs
Future research could randomize assignment of patients to the intervention or comparator cohorts. Research could also explore the effect of including patients and caregivers in the MTOC discussion. Future studies could use longer follow-up periods to evaluate the impact of multidisciplinary care on survival rates.
Final Research Report
View this project's final research report.
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Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- Reviewers asked for a more thorough description of the process of care in the multidisciplinary care and the serial care models, and more explanation of how patients entered the models. The researchers provided additional details on how referral patterns and provider choice determined which model of care patients received and what types of care patients received under each model.
- Reviewers commented that the different stages of lung cancer are likely to need different types of care. For instance, stage IV patients were less likely to need surgery or radiation, and many more stage IV patients entered the serial care arm than the multidisciplinary care arm. The researchers agreed that it would be important to use disease stage as subgroups in future analyses of survival but that the data are not yet fully available to complete such analyses.
- The reviewers noted that the researchers overstated the success of multidisciplinary care in improving the quality and outcomes of lung cancer care. In response, the researchers clarified that multidisciplinary care was measurably linked to patient- and caregiver-reported outcomes but not to clinical outcomes, like survival rates.