TY - JOUR
T1 - Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer
T2 - Impact on Patient Self-Management and Care Delivery in Safety-Net and Non-Safety-Net Centers
AU - Trosman, Julia R.
AU - Weldon, Christine B.
AU - Rapkin, Bruce D.
AU - Benson, Al B.
AU - Makower, Della F.
AU - Liang, Su Ying
AU - Kulkarni, Swati A.
AU - Perez, Claudia B.
AU - Lo, Shelly S.
AU - Krueger, Editha A.
AU - Throckmorton, Alyssa D.
AU - Gallagher, Christopher
AU - Hoskins, Kent
AU - Schaeffer, Cathleen M.
AU - Van Horn, Jennifer
AU - Schapira, Lidia
AU - Ravelo, Arliene
AU - Yu, Elaine
AU - Gradishar, William J.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - PURPOSE:Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non-safety-net institutions.METHODS:Ten institutions (five safety-net and five non-safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort.RESULTS:Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non-safety-net centers (87.6%, 74.2%, P =.001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P <.001) and ability to manage care (78.9%, 72.1%, P =.02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P =.045) and flu vaccination (38.6%, 27.9%, P =.001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non-safety-net patients, even after controlling for all other variables.CONCLUSION:4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non-safety-net patients, indicating that 4R may reduce care disparities.
AB - PURPOSE:Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non-safety-net institutions.METHODS:Ten institutions (five safety-net and five non-safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort.RESULTS:Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non-safety-net centers (87.6%, 74.2%, P =.001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P <.001) and ability to manage care (78.9%, 72.1%, P =.02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P =.045) and flu vaccination (38.6%, 27.9%, P =.001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non-safety-net patients, even after controlling for all other variables.CONCLUSION:4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non-safety-net patients, indicating that 4R may reduce care disparities.
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U2 - 10.1200/OP.21.00161
DO - 10.1200/OP.21.00161
M3 - Article
C2 - 34375560
AN - SCOPUS:85113881872
SN - 2688-1527
VL - 17
SP - E1202-E1214
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 8
ER -