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Breast Cancer and Interprofessional Care

breast cancer management and the importance of interprofessional careIn 1999, the IOM’s landmark report To Err is Human: Building a Safer Health System, explored the impact of medical errors on clinical outcomes in terms of human lives.1 Importantly, recommendations from that report included establishing interdisciplinary team training and implementing an interdisciplinary, collaborative approach to re-designing complex systems of healthcare delivery. Innovative and inclusive education and training were seen as critical for success because most care is indeed delivered by multidisciplinary, interprofessional teams of people, yet health care training is focused too often on individual responsibilities. In this series, we look at the importance of interprofessional care—and therefore, the continuing education needed to provide that care—in the management of specific disease states.

 

The Importance of Interprofessional Care in Managing Breast Cancer

Interprofessional and multidisciplinary teamwork is essential in the provision of healthcare.2 Today’s patients have complex health needs and typically require more than one discipline to address issues regarding their health status.3 The division of labor among medical, nursing and allied health practitioners means that no single professional can deliver a complete episode of healthcare.2 Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.4 Interprofessional education is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs.4 Interprofessional collaborative practice has been defined as a process which includes communication and decision-making, enabling a synergistic influence of grouped knowledge and skills.3 Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local health goals.4

A retrospective, comparative, interventional cohort study evaluated data from over 13,000 women diagnosed with symptomatic invasive breast cancer between 1990 and 2000 were included. The purpose was to determine whether the introduction of interprofessional care affected the survival of women with breast cancer. Teams comprised specialist breast cancer surgeons, pathologists, oncologists, radiologists, and specialist nurses. Adjusting for case mix, the researchers found that prior to the introduction of interprofessional teams, breast cancer mortality was 11% higher in the intervention area compared with other areas in the region; but after the teams were introduced, mortality was 18% lower than the other areas.5

Occupational therapy is a patient-centered service whose interventions focus on improving health, well-being, and functional capacity. Among the many millions of adult cancer survivors, many report decline in quality of life and limitations in basic and instrumental activities of daily living. Such limitations in functional status may be due to the cancer itself, but many are actually a result of treatment-related side effects and age-related functional decline.6 Several small studies have shown the benefit of occupational therapy in patients with breast cancer with improved daily functioning and quality of life.7–9 In addition to the need to improve lifestyles, patients with breast cancer may experience physical, cognitive and emotional impairments. The most common upper body symptoms reported by breast cancer survivors are related to shoulder impairments.10 There is substantial evidence supporting the effectiveness of different types of physical therapy in reducing upper-limb pain and lymphedema and improving shoulder range of motion (and, thus, shoulder function) in breast cancer survivors experiencing upper-limb morbidity.11,12

It is important for oncologists who provide comprehensive cancer care to be familiar with the principles of primary palliative care and interprofessional team-based approaches to palliative care. Palliative care is a medical subspecialty that provides specialized care to individuals with serious illnesses, with a primary focus on providing symptom relief, pain management, and relief from psychosocial distress; regardless of diagnosis or prognosis. Ideally, palliative care is provided by a team of physicians, nurses, social workers, psychologists, and chaplains. Early integration of palliative care has been shown to provide improved outcomes in patients with advanced cancer.13 A randomized, controlled trial found nurse-led, palliative care-focused intervention addressing physical, psychosocial, and care coordination provided concurrently with oncology care had higher scores for quality of life and mood.14

Supportive care refers to services that help cancer patients, their caregivers, and their families to cope with the disease and its treatment throughout the patient’s pathway and to help the patient maximizing treatment benefits in order to cope in the best possible way with the effects of the disease.15 Ultimately, supportive care aims to ensure and improve the quality of life (QoL) of the patient by covering different areas of supportive care, such as physical or symptom control needs, educational needs, social support, psychological support, spiritual support, and also rehabilitation support or end of life and bereavement care – a task that requires interprofessional cooperation and coordination.15 Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.16

Delivery of interprofessional, collaborative, patient-centered care is key to contemporary healthcare policy. Healthcare settings worldwide are therefore attempting to move away from a traditional organization of care, built around siloes of discipline-based specialization, towards an approach of delivering care through interprofessional teamwork.17,18 The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective healthcare delivery system.19 When members of the healthcare team understand each other’s professional roles and buy into the need of those roles complementing and depending on each other, the collaboration becomes more effective, thus improving safety and patient outcomes.4

Dr. Pollack is privileged to serve as the Medical Director for AcademicCME, https://academiccme.com/, a joint accredited education provider, where he is able to help develop innovative and engaging multidisciplinary, interprofessional programs aimed at improving patient care. This review of the importance of interprofessional education was initially developed by Michelle Yechout, lead medical writer at AcademicCME.

References

1. Institute of Medicine (US) Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. (Kohn LT, Corrigan JM, Donaldson MS, eds.). Washington (DC): National Academies Press (US); 2000. http://www.ncbi.nlm.nih.gov/books/NBK225182/. Accessed February 23, 2020.
2. Leggat SG. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health Serv Res. 2007;7:17. doi:10.1186/1472-6963-7-17
3. Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011;16. doi:10.3402/meo.v16i0.6035
4. World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice.; 2010. http://apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf. Accessed February 26, 2018.
5. Kesson EM, Allardice GM, George WD, Burns HJG, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012;344:e2718.
6. Pergolotti M, Williams GR, Campbell C, Munoz LA, Muss HB. Occupational Therapy for Adults With Cancer: Why It Matters. Oncologist. 2016;21(3):314-319. doi:10.1634/theoncologist.2015-0335
7. Petruseviciene D, Surmaitiene D, Baltaduoniene D, Lendraitiene E. Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer. Occup Ther Int. 2018;2018:6798697. doi:10.1155/2018/6798697
8. Hegel MT, Lyons KD, Hull JG, et al. Feasibility Study of a Randomized Controlled Trial of a Telephone-Delivered Problem Solving-Occupational Therapy Intervention to Reduce Participation Restrictions in Rural Breast Cancer Survivors Undergoing Chemotherapy. Psychooncology. 2011;20(10):1092-1101. doi:10.1002/pon.1830
9. Sleight AG. Occupational Engagement in Low-Income Latina Breast Cancer Survivors. Am J Occup Ther. 2017;71(2):7102100020p1-7102100020p8. doi:10.5014/ajot.2017.023739
10. Lozano-Lozano M, Martín-Martín L, Galiano-Castillo N, et al. Integral strategy to supportive care in breast cancer survivors through occupational therapy and a m-health system: design of a randomized clinical trial. BMC Med Inform Decis Mak. 2016;16. doi:10.1186/s12911-016-0394-0
11. Tatham B, Smith J, Cheifetz O, et al. The efficacy of exercise therapy in reducing shoulder pain related to breast cancer: a systematic review. Physiother Can. 2013;65(4):321-330. doi:10.3138/ptc.2012-06
12. De Groef A, Van Kampen M, Dieltjens E, et al. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96(6):1140-1153. doi:10.1016/j.apmr.2015.01.006
13. Swami M, Case AA. Effective Palliative Care: What Is Involved? Oncology (Williston Park, NY). 2018;32(4):180-184.
14. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198
15. Loibl S, Lederer B. The Importance of Supportive Care in Breast Cancer Patients. Breast Care (Basel). 2014;9(4):230-231. doi:10.1159/000366526
16. Cardoso F, Bese N, Distelhorst SR, Bevilacqua JLB, Ginsburg O, et al. Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast. 2013;22(5):593-605. doi:10.1016/j.breast.2013.07.050
17. Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: 2016 Update.; 2016. https://hsc.unm.edu/ipe/resources/ipec-2016-core-competencies.pdf. Accessed February 26, 2018.
18. Liberati EG, Gorli M, Scaratti G. Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care. Soc Sci Med. 2016;150:31-39. doi:10.1016/j.socscimed.2015.12.002
19. Mitchell P, Wynia M, Golden R, McNellis B, et al. Core Principles & Values of Effective Team-Based Health Care. National Academy of Medicine. October 2012. https://nam.edu/wp-content/uploads/2015/06/VSRT-Team-Based-Care-Principles-Values.pdf. Accessed December 11, 2017.

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