Reconsidering the team concept: Educational implications for patient-centered cancer care

https://doi.org/10.1016/j.pec.2009.09.020Get rights and content

Abstract

Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated ‘team’ concept, and suggest the concept of a ‘care community’ as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.

Introduction

The past two decades have seen breathtaking advances in imaging, genetics, molecular biology, and a number of other disciplines related to the diagnosis, treatment, and prevention of cancer. While such advances have led to powerful new patient care technologies, clinicians, educators, and researchers have increasingly stressed a need to combine the new technologies with patient-centered communication [1], [2]. The U.S. National Cancer Institute has established five research centers to focus specifically on communication, and the number of articles devoted to communication in cancer settings has increased exponentially over the past 10 years [3]. There have also been increasing efforts to educate oncologists and other cancer care providers in the skills needed for patient-centered communication [4], [5], [6]. In parallel with such efforts have been attempts to use a team approach to organize the delivery and enhance the patient-centeredness of cancer care [7]. In this essay, we examine several issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of the concept of tightly coordinated ‘teams’, and suggest a ‘care community’ as an alternate ideal for how cancer care might be delivered. We discuss the implications that this has for cancer communication education, and propose several principles to guide the development of educational interventions that strive to increase patient-centeredness in cancer care systems.

Section snippets

A case study of cancer communication

The following case is a composite based on several real patients’ stories. We do not intend it to be representative of the behaviors of all providers, but rather as an exemplar to illustrate the concepts that follow.

Tess is a 75-year-old woman with known colon cancer who presents to the hospital with hypotension and altered mental status. Tess's cancer story began 2 years prior, when she was hospitalized with a bowel obstruction. At that time, the surgeons removed a large mass in the colon, and

Educating communities to provide patient-centered cancer communication

A growing number of innovative programs are being developed to improve the patient-centered communication skills of oncologists and other oncology providers [22], [23], [24], [25], [26], [27], [28]. Such training programs usually are aimed at strengthening the abilities of providers to achieve one or more of the six core functions of cancer communication, and they often include innovative experiential methods such as trigger videos, patient and provider stories, self-reflection, role-play, and

Discussion

The shift from a concept of teams to that of care communities is not to be taken lightly. Often, transformations that seem so necessary, and which the members of organizations themselves endorse, become very difficult to achieve in practice. We anticipate that a community concept might be perceived as a threat to existing hierarchies, and that acting within this concept might create conflict and discomfort for community members who are not empowered in the current order. Education, then, is

Conflicts of interest

None of the authors has any actual or potential conflicts of interest, including any financial, personal, or other relationships with other people or organizations (within 3 years) that could inappropriately influence or be perceived to influence this work.

Acknowledgements

The Houston Center is supported by HFP 90-020 from the Office of Research and Development, U.S. Department of Veterans Affairs. Drs. Haidet and Teal are supported by K07-HL85622 from the National Heart, Lung, and Blood Institute. The funders had no role in writing or the decision to submit this report for publication.

The opinions contained herein are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs, the National Heart, Lung, and Blood

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