Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results

Abstract

Background: Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary vs. serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic.

Methods: We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care. We established a co-located multidisciplinary clinic to study the implementation of this care-delivery model. We identified and engaged key stakeholders from the onset, used their input to develop the program structure, processes, performance benchmarks, and study endpoints (outcome-related process measures, patient- and caregiver-reported outcomes, survival). In this report, we describe the study design, process of implementation, comparative populations, and how they contrast with patients within the local and regional healthcare system. Trial Registration: ClinicalTrials.gov Identifier: NCT02123797.

Results: Implementation: the multidisciplinary clinic obtained an overall treatment concordance rate of 90% (target >85%). Satisfaction scores were high, with >95% of patients and caregivers rating themselves as being "very satisfied" with all aspects of care from the multidisciplinary team (patient/caregiver response rate >90%). The Reach of the multidisciplinary clinic included a higher proportion of minority patients, more women, and younger patients than the regional population. Comparative effectiveness: The comparative effectiveness trial conducted in the last phase of the study met the planned enrollment per statistical design, with 178 patients in the multidisciplinary arm and 348 in the serial care arm. The multidisciplinary cohort had older age and a higher percentage of racial minorities, with a higher proportion of stage IV patients in the serial care arm.

Conclusions: This study demonstrates a comprehensive implementation of a multidisciplinary model of lung cancer care, which will advance the science behind implementing this much-advocated clinical care model.

Keywords: Lung cancer; implementation; multidisciplinary care; patient-centered; pragmatic.

Conflict of interest statement

Conflicts of Interest: Dr. R Osarogiagbon has the following potential conflicts of interest: stock ownership in Eli Lilly, Foundation Medicine and Pfizer; paid consultant for Association of Community Cancer Centers, Eli Lilly, Roche/Genentech; paid speaker for Roche/Genentech; patent application pending for a surgical lymph node specimen collection kit. The other authors have no conflicts of interest to declare.

Figures

Figure 1

Concentric circles of local to regional lung cancer patients. MD Clinic, all patients seen within the co-located multidisciplinary clinic from 2014 to 2016; MD Conference, patients discussed within a multidisciplinary case conference within the same institution during the same time period; Memphis Metro, patients diagnosed with lung cancer at the 2 hospitals serving Metropolitan Memphis, TN; Mid-South Region, patients diagnosed with lung cancer within all hospitals of the same healthcare system, including hospitals in Arkansas and Mississippi. The latter 2 data sets were collected from institutional Cancer Registry data for 2014 and 2015.

Figure 2

CONSORT diagram. *, patient inaccessible due to lack of appointments, telephone disconnection/number unknown, or loss to follow-up; **, % = completed/total eligible, % = completed/eligible adjusted for deaths.