When breast cancer patients’ doctors comanage their care with other specialists, the patients report greater satisfaction with their care. However, not all specialists are likely to share decision making with other physicians, according to a new study in Health Services Research.
“Breast cancer is typically a condition that is managed by multiple specialists. Often a surgeon is involved as well as a medical oncologist, radiologist and primary care physician,” said Katherine Kahn, MD, and senior author of the study.
Researchers conducted a survey of 347 breast cancer specialists, including medical oncologists, radiation oncologists, and surgeons. The specialists answered questions about their usual practice style for 10 clinical tasks associated with breast cancer care, including whether they manage common breast cancer treatment tasks independently, comanage tasks with other physicians, or refer patients to other providers. Radiation oncologists reported comanaging more tasks, followed by surgeons and medical oncologists.
Then, researchers identified satisfaction ratings from 411 patients matched to a surveyed medical oncologist. Medical oncologists who actively comanaged decision making in 4 different areas – choosing type of breast surgery, decisions about radiation, treatment of lymphedema, and treatment of depression – received higher rankings.
“Patients wanted to have one physician that they identified as coordinating their care – as co-managing, not just referring them out – and connected to all of the information that was relevant to the decision making for the patient,” Kahn said.
Certain factors impacted the comanagement of patients. Physicians in HMOs, who have greater access to other clinicians (compared with physicians in solo practice), were more likely to comanage patients. Physicians who received financial incentives to develop their own services or who encountered provider network restrictions in the referral process were less likely to work in partnership with other doctors when managing patient care.
“Perhaps one way of going forward is to look at this from the patient’s perspective,” said Richard Wender, MD, chairman of the department of family medicine at Jefferson Medical College and past president of the American Cancer Society.
“What patients want is the sense that they are being cared for in a continuous way,” Wender added. “We in the cancer care community increasingly recognize that we have a fundamental professional and ethical responsibility to take a patient-centered approach to cancer care. That means that the same kinds of interdisciplinary team thinking that has been applied to some other chronic illnesses must consistently be applied to cancer care.”
Source: Health Behavior News Service.