Elsevier

Surgical Oncology

Volume 20, Issue 3, September 2011, Pages 146-154
Surgical Oncology

Review
How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management

https://doi.org/10.1016/j.suronc.2011.06.004Get rights and content

Abstract

Background

Multimodal cancer care requires collaboration among different professionals in various settings. Practice guidelines provide little direction on how this can best be achieved. Research shows that collaborative cancer management is limited, and challenged by numerous issues. The purpose of this research was to describe conceptual models of collaboration, and analyze how they have been applied in the clinical management of cancer patients.

Methods

A review of the literature was performed using a two-phase meta-narrative approach. The first phase involved searching for conceptual models of collaboration. Their components and limitations were summarized. The second phase involved targeted searching for empirical research on evaluation of these concepts in the clinical management of cancer patients. Data on study objective, design, and findings were tabulated, and then summarized according to collaborative model and phase of clinical care to identify topics warranting further research.

Results

Conceptual models for teamwork, interprofessional collaboration, integrated care delivery, interorganizational collaboration, continuity of care, and case management were described. All concepts involve two or more health care professionals that share patient care goals and interact on a continuum from consultative to integrative, varying according to extent and nature of interaction, degree to which decision making is shared, and the scope of patient management (medical versus holistic). Determinants of positive objective and subjective patient, team and organizational outcomes common across models included system or organizational support, team structure and traits, and team processes. Twenty-two studies conducted in ten countries examining these concepts for cancer care were identified. Two were based on an explicit model of collaboration. Many health professionals function through parallel or consultative models of care and are not well integrated. Few interventions or strategies have been applied to promote models that support collaboration.

Conclusions

Ongoing development, implementation and evaluation of collaborative cancer management, in the context of both practice and research, would benefit from systematic planning and operationalization. Such an approach is likely to improve patient, professional and organizational outcomes, and contribute to a collective understanding of collaborative cancer care.

Introduction

Most cancer patients require multimodal assessment, treatment and follow up, often delivered by different professionals, in different settings, and at different time points [1], [2], [3]. Research has established that coordinated, collaborative service delivery improves clinical (ie. mortality, length of stay, readmission) and patient reported (ie. satisfaction, health related quality of life) outcomes for a variety of acute and chronic conditions [1], [4]. This necessitates interdependent decision making among multiple professionals, but may be challenged by structural and strategic differences between organizations, limited administrative support and reluctance to share resources and power so initiatives to foster interprofessional collaboration in everyday practice are needed [5], [6], [7], [8].

Evidence suggests that collaboration improves cancer care delivery and outcomes, but most cancer management guidelines do not specify how this is to be achieved [9]. A non-systematic review of the literature on multidisciplinary care in cancer found that formal policies and structures have been implemented in Australia, some European countries, the United Kingdom and the United States leading to improved interaction among professionals, treatment decisions, evidence based management, and patient outcomes [10]. However, in this and other studies, timely and appropriate collaborative cancer care and team functioning were found to be challenged by many patient, provider, team and system level factors [11]. In Canada, we too identified numerous challenges of collaborative cancer care through population based survey of, and interviews with health professionals across several studies. They identified numerous informational and logistical challenges including access to testing for diagnosis and staging in a timely manner, lack of standard and innovative human and technological resources, identifying and communicating with specialists, coordinating referral to and back from specialists, lack of or limited evidence supporting decisions about appropriate multidisciplinary management of complex cancer patients, confusion among multidisciplinary team members about who was to order or coordinate management, the need for system level support of collaborative decision making and management, and the need for cancer management professional development opportunities [12], [13], [14], [15], [16], [17], [18], [19], [20].

Clearly, efforts are needed to promote and support collaboration for the clinical management of cancer patients. However, reviews of published research found few empirical studies that support any particular model of collaborative cancer care [21], [22]. Furthermore, research and practice in this area is complicated by incomplete development of concepts, leading to inconsistent operationalization of interventions and evaluation measures [23], [24]. For example, relevant published work in this area refers to collaborative care, integrated care, teamwork, interprofessional, multiprofessional and/or multidisciplinary care. Greater understanding of which collaborative models lead to improved patient, provider and organizational or system outcomes is needed [25], [26], [27]. First it is necessary to characterize research on collaborative care delivery for cancer patients. This would identify the conceptual models and associated aspects that have been studied, and methodological approaches used, highlighting issues not previously studied but that warrant further investigation. Therefore the purpose of this study was to define the conceptual models of collaborative care, and then use that framework to assess the way that collaborative care has been applied or evaluated in empirical research on the clinical management of cancer patients.

Section snippets

Methods

A review of the literature was performed using a two-phase meta-narrative approach [28]. This method is suitable for conceptually examining literature that may vary in focus and study design as a needs assessment by which to generate a plan for ongoing research. The first phase included initial communication between the authors to establish key concepts of interest, searching for models related to key concepts, and summary of their components and limitations. The second phase included targeted

Concepts and models

Primary and synthesized research describing models of health professional interaction for patient management according to the concepts of teamwork, interprofessional collaboration, continuity of care, integrated service delivery, interorganizational collaboration and case management was summarized in Table 1.

Empircal research on clinical management of cancer patients

Empirical research evaluating health professional interaction for the clinical management of cancer patients, factors influencing their interaction, or interventions designed to improve

Discussion

While the inherent nature of cancer requires that it be managed in a collaborative manner there are no established models for how this should be operationalized or evaluated. To guide ongoing policy, practice and research a common understanding of collaboration is needed. The purpose of this study was to generate such insight by describing models of collaboration, and using that framework to assess the way that collaborative care has been applied or evaluated in empirical research on the

Conclusions

Analysis of health services research on cancer management according to available models of collaboration revealed numerous challenges in delivering cancer care that involves multiple health professionals. Few interventions have been applied to overcome these challenges, and empirical research in this area appears to be limited in volume and conceptual underpinning. Ongoing development, implementation and evaluation of collaborative cancer care, in the context of both practice and research,

Conflict of interest statement

The authors have no financial, personal or other relationships with people or organizations that could inappropriately influence their work.

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