Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study

Abstract

Executive SummaryMultidisciplinary tumor boards involve various providers (e.g., oncology physicians, nurses) in patient care. Although many Community Hospitals have local tumor boards that review all types of cases, many providers, particularly in rural areas and smaller institutions, still lack access to tumor boards specializing in a particular type of cancer (e.g., breast, gastrointestinal, hematologic). Videoconferencing technology can connect providers across geographic locations and institutions; however, virtual tumor board (VTB) programs using this technology are uncommon.In this study, we evaluated the feasibility of a new VTB program at UNC Lineberger Comprehensive Cancer Center, which connects community-based clinicians to UNC tumor boards. We used an embedded case study design with UNC VTB as the overarching case, comprised of multiple tumor boards representing different cancer types, each with individual clinician participants (our primary unit of analysis). Methods included observations, interviews, and surveys. § Corresponding Author: 135 Dauer Dr., CB # 7411, Department of Health Policy and Management, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, chris_shea@unc.edu, Phone: 919-966-1938, Fax: 919-966-6961. COMPETING INTERESTSThe authors report no competing interests.The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptOur findings suggest that participants were generally satisfied with the VTB. Cases presented at VTB were appropriate, sufficient information was available for discussion, and technology problems were not common. UNC clinicians viewed the VTB as a service to patients and colleagues and an opportunity for clinical trial recruitment. Community-based clinicians presenting at VTB valued the discussion, even if it simply confirmed their original treatment plan or did not yield consensus recommendations. However, barriers to participation for communitybased clinicians included timing of the VTB and lack of reimbursement. To maximize benefits of the VTB, barriers to participation should be addressed, scheduling and preparation processes optimized, and appropriate measures for evaluating impact identified. Keywordsvideoconferencing; health services accessibility; oncology service; hospital; interdisciplinary communication; patient care management BACKGROUNDMany health care systems across the world have adopted a multidisciplinary approach to cancer care. This approach, intended to facilitate communication between care providers by effectively using information (e.g., research findings) to improve quality and continuity of care, is important given the increasing complexity of managing cancer patients (Taylor et al., 2010). One venue for this approach is a multidisciplinary tumor board (or multidisciplinary cancer conference), where clinicians presen...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

“…In the first year of the regional VTB, access to expert body radiologist interpretation of magnetic resonance imaging and computed tomography imaging reduced diagnostic liver biopsy rates from 24% to 6% and access to the academically affiliated, hepatology-driven multidisciplinary team reduced the time to receipt of active HCC therapy for rural Veterans by nearly 30 days. 20 Although telehealth-based VTB have strong potential to reduce diagnostic delays and to speed development of comprehensive treatment plans, significant barriers to implementation exist both within 45 and outside the VA, 46 including challenges related to timing, care coordination, patient travel/satisfaction, and expert/referrer compensation. Thus, optimization of efficient approaches to deliver expert HCC care for patients living in medically underserved or geographically remote areas requires further study.…”

Leveraging Technology for Remote Learning in the Era of COVID-19 and Social Distancing

“…Tumor Boards -Pathologists play a key role at multidisciplinary tumor boards, discussing pathology cases and showing pertinent features. Both of these roles are easily shifted to virtual collaborative conference spaces ("virtual tumor boards") such as the ones listed above 12 . As of March 2020, the authors of the article are already using various video conferencing platforms for tumor boards and other multidisciplinary conferences, eliminating the need for an in-person tumor board in a meeting room.…”

<p>Health Professionals’ Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study</p>

“…8,9 Virtual MDTMs have been shown to connect geographically spread experts with benefits that particularly relate to improved coordination of care for patients in rural and remote areas and to treatment recommendations for complex cases and rare diseases. 2,[10][11][12][13][14] The MDTM network also provides possibilities for competence development for participating health professionals. 8 Difficulties related to virtual MDTMs include dysfunctional technology, concerns about confidentiality, coordination challenges between hospitals and limited patient-centeredness.…”