Purpose: A multiphased QI project to increase multidisciplinary team member (social work, dietician, mental health and palliative care) visits for patients with stage IV lung cancer receiving antineoplastic therapy.
Background: The Commission on Cancer program standards require an active multidisciplinary team to meet the needs of the patient. Prior to the addition of oncology navigators at the Minneapolis VA, patients received supportive services through consults placed by the oncologist, infusion clinic nurses or patient requests. Patients were not receiving care from these disciplines for a variety of reasons, including lack of a standardized process to trigger the initiation of a consult, physicians focusing on antineoplastic therapy, lack of room space in the clinic, and the stigma associated with mental health and palliative care to the layperson. It was thought that navigators may be able to assume the role of initiating the consults and coordinating the visits because they typically meet with each patient for chemo education.
Methods: The ACCESS database used to track oncology consults was reviewed for stage IV lung cancer patients receiving parental antineoplastic treatment from January 2015 through April 2017. Patients transferring care before the completion of therapy were excluded. Charts were reviewed to determine time from consult to therapy, visits with a social worker, dietician, mental health provider and palliative care consults. A contact included any visit both inpatient or outpatient during the treatment period.
Results: There were 191 lung cancer patients, 78 met the inclusion criteria. Ninety percent (70/78) of patients had contact with a navigator. 76% of the patients received palliative care, 69% contact with a social worker, 39% received a mental health provider visit and 64% received
a consult with a dietician.
Conclusions: It is feasible for a nurse navigator to coordinate visits among multiple specialties. Coordinating the visits in the infusion center leads to increased utilization of the specialty services, freed up rooms the provider clinic and normalized the inclusion of mental health and palliative care early in the treatment course.