Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

Abstract

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient’s Breast Cancer Care Initiation

“…9,19,30 Failure to effectively time/sequence interdependent care impedes teamwork among providers 31,32 and causes care delays, breakdowns and changes in care trajectories. 16,22,23,33,34 …”

“…Project management is uniquely suited to manage teamwork in oncology. 23 It inherently addresses the four care delivery challenges highlighted above (Table 1). It provides a systematic, yet flexible approach to structuring teamwork and adapting to different care settings and environments.…”

“…We previously proposed the 4R approach to facilitate rigorous, patient-centric teamwork in oncology, leveraging the Project Management discipline 23,30,38 (Table 1). Under this approach, care for a cancer patient is managed as a project, using a care project plan (“Care Sequence”), which specifies timing and sequencing of interdependent care events across clinical domains relevant to the patient’s care.…”

“…Building on previous work by Taplin et al 22 and Trosman et al, 23 this article explores barriers to optimal care during breast cancer care initiation and how they could be addressed by teamwork and patient engagement, highlighting the potential role of radiology in the optimized process. We analyze how an innovative 4R Approach - Right Information and Right Care for the Right Patient at the Right Time © - for facilitating teamwork in cancer care, introduced by Trosman et al, may be applied to breast cancer care initiation and a value-added role for radiology.…”

“…22 Similarly, Trosman and colleagues focused on care breakdowns and opportunities for teamwork during breast cancer treatment. 23 However, to our knowledge, the care initiation phase – from diagnosis to start of treatment – remains unexplored in this context.…”