The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework

Abstract

Care coordination challenges for patients with cancer continue to grow as expanding treatment options, multimodality treatment regimens, and an aging population with comorbid conditions intensify demands for multidisciplinary cancer care. Effective teamwork is a critical, yet understudied, cornerstone of coordinated cancer care delivery. For example, comprehensive lung cancer care involves a clinical “team-of-teams”—or clinical multiteam system (MTS)—coordinating decisions and care across specialties, providers, and settings. The teamwork processes within and between these teams lay the foundation for coordinated care. While the need to work as a team and coordinate across disciplinary, organizational, and geographic boundaries increases, evidence identifying and improving the teamwork processes underlying care coordination and delivery among the multiple teams involved remains sparse. This commentary synthesizes MTS structure characteristics and teamwork processes into a conceptual framework called the cancer Multiteam System (cMTS) Framework to advance future cancer care delivery research addressing evidence gaps in care coordination. Included constructs were identified from published frameworks, discussions at the 2016 NCI-ASCO Teams in Cancer Care Workshop, and expert input. A case example in lung cancer provided practical grounding for framework refinement. The cMTS framework identifies team structure variables and teamwork processes affecting cancer care delivery, related outcomes, and contextual variables hypothesized to influence coordination within and between the multiple clinical teams involved. We discuss how the framework might be used to identify care delivery research gaps, develop hypothesis-driven research examining clinical team functioning, and support conceptual coherence across studies examining teamwork, care coordination, and their impact on cancer outcomes.

Geographic differences in community oncology provider and practice location characteristics in the central United States

“…13,14 These can include: structural characteristics of the "firm" or organization in which care is delivered, such as its size and subsequent specialization as size and competition increase; relational characteristics of the individuals within the organization-shared characteristics which facilitate common goals, leading to the congruence of practice patterns; and social networks outside the organization, which support the adoption of innovation. [15][16][17][18] Without an understanding of the practice context, including the characteristics, and potential interactions, of those providing care, implementation of evidence-based interventions may fail. 19 Thus, understanding the social and physical context in which rural oncologists care for cancer patients is critical to reducing geographic disparities.…”

Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research

“…Although new treatments have extended survival or averted death, these therapies are not without physical, psychosocial, and financial sequelae that often limit function and full participation in life and must be managed beyond active treatment [ 45 , 46 ]. The patient’s health, social, psychological, and financial needs often have to be managed interdependently among a team-of-teams—or multi-team system (MTS)—of clinicians and allied health care professionals across diverse health care “system of systems” [ 47 , 48 ]. For example, survivors receiving multi-modal cancer therapy who also manage a chronic condition may have multiple oncology teams (i.e., medical, surgical, radiation), primary care (for preventive and chronic disease management), and specialty care (e.g., endocrinologist, cardiologist).…”

“…For example, how these teams develop shared understandings (e.g., shared mental model, role clarity, shared leadership, boundary spanning, trans-active memory) among multi-team system members of different specialties across contexts remains understudied. Future research on MTS should consider drawing from teaming frameworks and teamwork measures in health care delivery [ 21 , 47 , 69–78 ]. For example, Verhoeven’s Teaming in Cancer Care Delivery Framework identifies and defines team structure characteristics and teamwork processes that contribute to optimal care coordination relevant to both observational and interventional research [ 47 ].…”

“…Future research on MTS should consider drawing from teaming frameworks and teamwork measures in health care delivery [ 21 , 47 , 69–78 ]. For example, Verhoeven’s Teaming in Cancer Care Delivery Framework identifies and defines team structure characteristics and teamwork processes that contribute to optimal care coordination relevant to both observational and interventional research [ 47 ].…”

The Next Step in Tumor Board Evolution: Optimizing Care Coordination and Integration

“…Patients frequently experience this process as a disjointed set of visits, tests, and procedures. The resulting care fragmentation creates anxiety and delays 4 . Many centers have worked to optimize the process of care coordination through patient navigation services and other supportive interventions.…”