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

Abstract

Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction competence, and teamwork skill set.

Keywords: Cancer; breast cancer; breast cancer diagnosis; models of care; patient engagement; radiology care delivery; team-based care; teamwork.

Figure 1. Case of Patient A. Genetic Assessment Prior to Surgery

Insurance eligibility and network verification issues and other delays PCP – Primary Care Physician Diagram is not to the actual time scale

Figure 2. Case of Patient B. Neoadjuvant Therapy

Patient delays due to childcare and work schedule issues (present in scenario a, but resolved in scenario b) PCP – Primary Care Physician Diagram is not to the actual time scale

Figure 3. Case of Patient C. Example of Care Initiation Sequence

d1–d10, days, beginning with diagnosis C- The patient PCP – Primary Care Physician A Bar represents treatment / care; a Diamond represents a visit / decision. Responsibility would be filled in with specific names of providers