GI Clinicians Tackle Fractured Care

Fractured Care

The Duke team of clinicians, behavioral scientists, biostatisticians, community engagement specialists will spend the first six months of the DCN Passport study conducting surveys of, and in-depth interviews with, gastric and GEJ cancer patients, their families and providers within DCI and the Duke Cancer Network about symptoms and quality-of life, ease of obtaining care, barriers to care, and satisfaction with care.

They already have some clues as to what they’ll find :

• In a recent study analyzing the National Cancer Database, gastric/GEJ cancer survival was found to be worse in those patients who received care from multiple institutions (designated “fractured care”) as opposed to one center. The region in which the Duke Cancer Network resides, the researchers noted, has one of the highest rates of fractured care in the country.
• In a survey last year of DCN and DCI patients (who were undergoing surgery, radiation and chemotherapy for gastric or GEJ cancer) and their providers to assess treatment compliance challenges, the investigators found patient-physician communication, hospital navigation, transportation, and low-volume services to be the top concerns.

During the next phase of the study, the research team will test market the new patient navigation tool they’re developing — “DCN Passport”— to try and break down some of those barriers; beginning with a projected 30 patients from DCI and three DCN affiliate hospitals: Maria Parham Health (Henderson), Scotland Health Care System (Laurinburg), and Southeastern Health (Lumberton).

The concept of the DCN Passport came from Nussbaum and was conceived as a tool to improve delays in or noncompliance with care. As the (study-enrolled) patient’s treatment plan/goals of care are decided at the weekly DCI/DCN gastric/GEJ cancer tumor board, it will be entered into a computerized form using DCN PassPoint software, printed on stickers and affixed to a physical booklet, the DCN Passport. The data, which will be stored on a secure server, can easily be edited to accommodate any changes.

“Having a hard copy in the patient’s hands will ensure accessibility,” said Blazer. “The expectation is that patients will carry their DCN Passport to all appointments, and mark the completion of each scheduled treatment.”

Patient Empowerment

Eventually, the study will be expanded to the remaining DCN affiliates in the Southeast— for a total estimated enrollment of between 180 and 230 patients by the time of project completion. A full evaluation will be conducted at close-of-project.

“We anticipate higher rates of patient adherence to their multi-disciplinary treatment plans that could potentially translate to improvements in their quality of life and overall survival,” said Blazer. “We also anticipate greater satisfaction with complex treatment plans across diverse hospital settings.”

Sutton, medical director of the Duke Cancer Network, believes that enrollment in the DCN Passport program could improve treatment plan compliance by as much as 50 percent, based on a similar project she led in the breast cancer setting.

“The patient experience along the diagnostic and treatment journey can be challenging and frustrating to both patients and providers as patients travel between health systems; the resulting fractured care  can negatively impact outcomes,” said Sutton. “This project addresses the threat to successful outcomes in a novel way that empowers and engages patients in their care.”

If the DCN Passport works as expected, the team plans to offer the program to other disease sites in the DCN, and potentially provide a no-cost template to other institutions and providers.