According to a novel investigation in Health Services Research, greater satisfaction is reported among individuals with breast cancer when their doctor co-manages their care with other specialists. Although, some specialists are more likely to share decision-making with other physicians. Katherine Kahn, M.D., of the David Geffen School of Medicine at UCLA and senior author of the investigation, explained:

“Breast cancer is typically a condition that is managed by multiple specialists. Often a surgeon is involved as well as a medical oncologist, radiologist and primary care physician.”

The best approach for specific tasks connected with cancer diagnosis and treatment, may be co-management, where two or more physicians consult with each other. Although, in breast cancer care it is unknown to which extent specialists co-manage.

347 breast cancer specialists, including surgeons, medical oncologists, and radiation oncologists were surveyed in the investigation, regarding their typical practice style for 10 clinical tasks linked to breast cancer care. The survey contained questions regarding if they manage common breast cancer treatment tasks independently, co-manage tasks with other physicians, or refer patients to other providers. Co-managing was reported more by radiation oncologists, followed by surgeons and medical oncologists.

The team identified satisfaction ratings from 411 patients of surveyed medical oncologists, in order to analyze patient outcomes. Medical oncologists who actively co-managed decision making received higher ratings from patients than those who referred patients to another specialist in four different areas: treatment of depression, selecting the type of breast surgery, treatment of lymphedema (limb swelling after breast surgery), and decisions regarding radiation.

Kahn explained:

“Patients wanted to have one physician that they identified as coordinating their care as co-managing, not just referring them out and connected to all of the information that was relevant to the decision making for the patient.”

The team found certain factors that were connected with co-managing patients. Physicians in HMOs were more likely to co-manage patients and had greater access to other physicians and clinicians than physicians in solo practice. Physicians less likely to co-manage patients were those who received financial incentives to expand their own service or physicians who faced barriers to referral due to provider network restrictions.

Richard Wender, M.D., chairman of the department of family medicine at Jefferson Medical College and past president of the American Cancer Society, said:

“Perhaps one way of going forward is to look at this from the patient’s perspective.

What patients want is the sense that they are being cared for in a continuous way. We in the cancer care community increasingly recognize that we have a fundamental professional and ethical responsibility to take patient-centered approach to cancer care. That means that the same kinds of interdisciplinary team thinking that has been applied to some other chronic illnesses must consistently be applied to cancer care.”

Written by Grace Rattue