Multidisciplinary Care: Tap Into the Nonclinical Care Force

Multidisciplinary care teams are an important aspect of patient-centered care and are slowly become more common place at community cancer centers. For those working at smaller hospitals or centers, it is important to use every type of resource available and in a lot of cases those resources include the nonclinical care force including family members, clergy, and volunteers.

At the Association for Community Cancer Centers (ACCC) 40th Annual National Meeting, Virginia T. Vaitones, MSW, OSW-C, president of the association, moderated a panel discussion on the multidisciplinary care team and how best to engage a cancer center’s nonclinical care force.

Marie Garcia, RN, OCN, of Virginia Cancer Specialists, PC, said that taking advantage of the available community resources is of vital importance at her practice.

“We make sure that we are well connected to the hospital settings that are within our communities,” Garcia said.

Garcia’s group is QOPI certified and therefore gives its patients a distress tool to try to evaluate areas of need. Garcia said that although it was a big project to undertake, the distress tool has yielded important information on patient needs. For example, the tool identifies patients who seek out nutritional help, spiritual counseling, financial assistance, or social work help and, although those commodities are not always available at her practice, the practice is able to put them in touch with community partners.

Linda Ferris, PhD, vice president, Oncology System Service Line, Centura Health Cancer Network, agreed with Garcia stating that her group also makes sure to tap into all available external resources. However, she also admitted that her group may not take full advantage of the volunteer talent available to them.

“When I see an elderly patient coming in with their 55- or 60-year-old daughter, I should be thinking ‘There goes a good volunteer when she retires,’” Ferris said. “One in five of us are going to be over the age of 65 by 2020, and that is going to be a great resource in volunteers to potentially help our programs and allow for creative solutions in small communities.”

The role of the patient navigator and social workers also cannot be undervalued, added Mark Soberman, MD, MBA, FACS, medical director, Oncology Service Line, Frederick Regional Health System. In fact, at his group the patient navigator is the first person the patient sees at their multidisciplinary visit, and dedicated social worker is the last. Together these two team members have time to go through and figure out what resources are required by the patient. Soberman’s group also takes advantage of other resources, such as the Maryland state run Survivors Offering Support (SOS) program, which matches patients with breast cancer with other breast cancer survivors of a similar age, ethnicity, and demographic. 

At C-Change, tapping into nonclinical resources has been a huge focus, according to panelist Tom Kean, MPH, president and CEO of C-Change.

“We have issues with having enough providers in the oncology specialty arena, and we always assume that PCPs will pick up that extra responsibility, but PCPs have issues as well,” Kean said.

Who will this extra responsibility fall on then, Kean asked. In many cases it will be patient caregivers, such as family members, friends, or partners, but there is also a whole other array of people in community agencies that are providing services to patients when they are in trouble, whether it be with pain, finances, or nutrition.

“We are talking about clergy, volunteers at hospitals, hospices, and other environments, and a whole other group of people that are involved in the care of patients,” Kean said.

C-Change spent time talking with these groups of people about how they view their role, and the first thing they mentioned is that they feel they have no visibility, Kean said.

“They are essentially this hidden set of partners that is out there, and because they have no visibility they have no interaction with the health care team,” he said.

It is important that cancer programs begin to recognize the important role that these other caregivers or organizations have in cancer patients’ treatment, because only then can programs begin to engage them. Kean said that in C-Change’s discussions with these groups they expressed active interest in increasing their knowledge and core competencies when it comes to cancer.