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Team complexity and care coordination for cancer survivors with multiple chronic conditions: a mixed methods study

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Abstract

Purpose

Little is known about the perceptions and experiences of care received from healthcare teams among cancer survivors with multiple chronic conditions (MCCs).

Methods

Cancer survivors completed an online survey (N=441) of which 12 participated in an interview. Team complexity was operationalized based on team size, clinician specialties, and health system affiliation. Kilpatrick’s Patient-Perceptions of Team Effectiveness (PTE) questionnaire measured team effectiveness. Constant comparative method was used to identify care coordination challenges and facilitators from interviews.

Results

Mean age at cancer diagnosis was 45 years (SD=14), 68% were 5 years from diagnosis, the most common cancer was breast (27%), and two-thirds had two or more pre-diagnosis comorbidities. Sixty percent rated both cancer and other condition(s) as taking priority. Team complexity varied from low (32%), moderate (49%), and high (20%). Eighty percent rated PTE overall as high, with variation by subscales: coordination (85%) and patient-family focus (47%). Higher team complexity was associated with lower PTE overall (p=0.049). Challenges were identified: sequential referrals with no integration across team members; no shared mental model among team; and cancer survivor having to “referee” conflicting care decisions.

Conclusion

This mixed method study found an inverse relationship between team complexity and PTE-overall, where high-complexity teams had lower team effectiveness. Participants reported issues with the problem-solving abilities of their teams and felt like their contributions were not valued by their care team.

Implications for cancer survivors

Improving team effectiveness offers one way to leverage the expertise of multiple specialties to deliver integrated, patient-centered care for the growing population of cancer survivors with MCC.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Research reported in this publication was supported by the 2022 William G. Coleman Minority Health and Health Disparities Research Innovation Award issued by the Intramural Research Program of the National Institute on Minority Health and Health Disparities.

Funding

This work was supported by the 2022 William G. Coleman Minority Health and Health Disparities Research Innovation Award issued by the Intramural Research Program of the National Institute on Minority Health and Health Disparities.

Author information

Author notes

  1. Dana Verhoeven and Michelle Doose contributed equally to this work as first authors.

Authors and Affiliations

  1. Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Dana Verhoeven, Veronica Chollette & Sallie J. Weaver

  2. Department of Health Services Research and Administration, College of Public Health, 984355 University of Nebraska Medical Center, Omaha, NE, 68198, USA

    Dana Verhoeven

  3. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Michelle Doose

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  1. Dana Verhoeven
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  4. Sallie J. Weaver
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dana Verhoeven and Michelle Doose. The first draft of the manuscript was written by Michelle Doose and Dana Verhoeven, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dana Verhoeven.

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This article was produced by employees of the US government as part of their official duties. Findings and conclusions are those of the authors and do not necessarily represent the official views of the National Institutes of Health, National Cancer Institute, or other federal agencies.

Ethics approval

The NIH Institutional Review Board approved all study procedures under IRB exemption (NIH IRB protocol #000762).

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Informed consent was obtained from all individual participants included in the study.

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Verhoeven, D., Doose, M., Chollette, V. et al. Team complexity and care coordination for cancer survivors with multiple chronic conditions: a mixed methods study. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-023-01488-w

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