Improving Patient Care With Interprofessional Collaborative Oncology Practice

Polly Mazanec, PhD, ACNP, AOCN, FPCN

Polly Mazanec is an assistant professor at the Frances Payne Bolton School of Nursing at Case Western University in Cleveland, Ohio.

To meet the complex healthcare demands of today’s patients, healthcare professionals need to learn how to practice as members of an interprofessional collaborative team. Here at the Frances Payne Bolton (FPB) School of Nursing, we have placed a priority on advancing interprofessional collaborative practice in oncology through several interprofessional education (IPE) initiatives.

Although oncology nurses traditionally have recognized the importance of our colleagues in social work, psychology, and chaplaincy, as well as medicine, we often work with these colleagues as consultants/referrals rather than as members of the patient’s and family’s oncology team. Each professional contributes to the care of the patient and family, but often in the silos of his or her respective discipline. This model of practice has been part of clinical training, which historically has been discipline-specific, with little opportunity to engage in interprofessional experiences.¹

Recently, however, many professional training programs have initiated interprofessional collaborative practice educational experiences at both the undergraduate and graduate level to help trainees from many healthcare disciplines learn to work in teams.

What Is Interprofessional Education?

Interprofessional education has been defined as “an intervention where the members of more than one health or social care profession, or both, learn interactively together, for the explicit purpose of improving interprofessional collaboration (IPC) or the health/wellbeing of patients/clients, or both.”² In 2011, the Interprofessional Education Collaborative issued core competencies for interprofessional collaborative practice.³ The expert panel included representatives from the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health. The expert panel established the four essential competency domains for interprofessional practice:

• Values/ethics for interprofessional practice
• Roles/responsibilities
• Interprofessional communication
• Teams and teamwork

Many medical schools and nursing programs are beginning to integrate IPE into their curricula. Programs offer didactic sessions together, and many now are introducing interprofessional clinical experiences where the application of IPC principles is encouraged. Healthcare professionals trained in IPC are more likely to demonstrate respect for other professionals’ roles and responsibilities and to become collaborative members of the team.⁴ Ultimately, this collaboration has been shown to improve patient outcomes of quality and safety for a variety of acute and chronic illnesses.⁵ Such training is especially important for quality cancer care.

FPB Interprofessional Curriculum

For the past two years, the Adult-Gerontology Primary Care Oncology & Palliative Care MSN program at FPB has offered its two semesters of symptom management courses as interprofessional classes. We have partnered with the University Hospitals Seidman Cancer Center Oncology Fellowship program and the MetroHealth & Hospice of the Western Reserve Palliative Medicine Fellowship to present symptom management sessions on interprofessional topics, such as cancer pain management, the ethics of medical decision-making, and common symptoms of advanced cancer, in an interprofessional format.

The two-hour sessions combine one hour of didactic instruction with one hour of team-based case studies. A faculty member from the three areas (nursing, oncology, and palliative medicine) facilitates a group of students and guides the discussion within the core domains of IPE: valuing and respecting disciplines, roles and responsibilities, communicating as a team, and teamwork.

Translation Into Practice

FPB has been involved also in integrating IPE into clinical practice. The school has participated for more than two years in a project on Interprofessional Specialty Care-Cancer at the Louis B. Stokes Cleveland VA Medical Center. Nurse practitioner students have the opportunity to work as trainees in an interprofessional oncology clinical practice with other trainees from medicine, oncology, social work, psychology, and nursing.

The NP students are able to apply their classroom education to the clinical setting in the care of patients with breast cancer, melanoma, lymphoma, or sarcoma. They participate in the clinic weekly for eight weeks at a time. A 90-minute team huddle begins the clinic day, with all disciplines contributing to the patient plan of care prior to the visit.

Students stay in the patient clinic, visit while each discipline assesses the patient and family needs, and learn the roles and responsibilities of all members of the team. The day ends with a 30-minute patient review where the trainees discuss plans of care. This project, funded by the VA Offices of Academic Affairs and Specialty Care, has successfully integrated the core domains of IPE into the training experience.

Quality cancer care in the 21st century demands a team approach to attend to patient and family physical, psychological, social, and spiritual needs.

However, working in an interprofessional collaborative practice requires training to become a successful team. Opportunities to learn the principles of interprofessional practice are emerging in educational programs, but these need to be made available to oncology professionals already in practice if we are to improve patient outcomes and deliver quality cancer care.

References

• Bridges DR, Davidson RA, Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011;16:6035.
• Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013.
• Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. May 2011. http://www.aacn.nche.edu/education-resources/ipecreport.pdf. Accessed May 20, 2014.
• Barker K, Oaandasan I. Interprofessional care review with medical residents: lessons learned, tensions aired—a pilot study. J Interprof Care. 2005;19(3):207-214.
• Gagliardi A, Dobrow M, Wright FC. How can we improve cancer care? a review of interprofessional collaboration models and their use in clinical management. Surg Oncol. 2011;20(3):146-154.