The waiting is the worst. Any patient waiting for a cancer diagnosis – or not – will tell you that.
A new pilot program developed at Yale Cancer Center offers patients next-day access for oncologic consultations, which researchers say should reduce wait times for treatment and increase patient satisfaction, according to a new report.
“We have not proven that people do better” with next-day-appointments, said Dr. Sarah Mougalian, deputy chief ambulatory officer at Smilow Cancer Hospital and Yale Cancer Center and lead author of the study. “We have not proven that people who are seen faster have better outcomes, but just from a sheer patient anxiety perspective, we’ve seen that we’re able to do that.”
Many patients who receive a diagnosis of cancer can wait days to more than a week to see a specialist or team of specialists who can inform them about the type of cancer they have and offer them a likely treatment plan. Much of that involves pulling together records – imaging films, pathology reports, biopsy reports and a patient’s medical history.
If patients have been treated within the same medical system, that process, especially with the advent of electronic medical records – can be done almost immediately. But many patients have received care or diagnostic imaging at a variety of facilities, making the process of gathering the date more time-consuming.
Mougalian and her colleagues wanted to see if it was technologically and organizationally possible to bring a patient in to a specialist within a day. Their study found it was possible, and, if patient expectations were managed, many patients – though not all – were relieved to see a cancer team within 24 hours.
“We have to manage expectations,” Mougalian, associate professor of medicine (medical oncology) and lead author of the study. “If I require five pieces of information to render a treatment plan, the patient needs to understand that I may need those two pieces of information before I’m able to render a treatment plan. The study found that some patients would jump at the opportunity. Others would rather wait, she said, until all the data is collected or until they can see a specialist of their choice.
It the study of 3,107 new patients seen across the four pilot sites, more than half (56%) responded that a timely appointment was important when choosing cancer care. Another 41% of the patients wanted to wait for a specific specialist. Overall, the study found 96% of patients said the next-day-access program met or exceeded their expectations.
“It’s very patient-specific,” Mougalian said. “They may only want to see that doctor because (their) Aunt Sally saw that doctor and loved him. People may feel very specific about a doctor. Ultimately, it’s not for me to decide when you are seen, it’s up to you.”
The next-day access program Mougalian and colleagues developed is a “blueprint” for faster oncologic consultation in two subspecialty clinics and two Smilow Cancer Hospital Care Center Network sites. Each pilot team created an implementation plan for breast and gynecological cancer patients, with algorithms defining which patients are “eligible” for next-day access. Mougalian said the study data, which was presented on Sept. 24, at the American Society of Clinical Oncology Quality Care Symposium, offers hospital systems a way to offer next-day access. The question will be whether such systems and physicians are eager to participate.
“Success of this pilot required extensive effort to address change management and perceived barriers, but the results are very encouraging,” said Mougalian. “Deployment in other disease teams and at additional community sites is underway.” Yale Cancer Center expects to roll the program out slowly at some of its sites, including Guilford and Trumbull. However, Mougalian said the process, which will ultimately include Torrington and Waterbury, is months to years away.
“Delays in access to treatment have been shown to cause anxiety and distress in patients with cancer and even more troublesome, worse outcomes,” she said. “It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation.”
Other Yale authors involved in the study include Lisa Shomsky, Maureen Major Campos and Anne C. Chiang.
Source: Republican-American