Complex care, is well, complex -- and no more so than when a newly diagnosed cancer patient with comorbidities—specifically high blood pressure, diabetes and elevated cholesterol—has to go for follow-up appointments with multiple care providers at different sites.
What turns “good” care into “poorly coordinated care” is usually a lack of communication between specialists and primary care providers. To bridge the communication and coordination gap and break down the care siloes, Duke population health scholars Leah Zullig and Kevin Oeffinger from the Duke University School of Medicine developed ONE TEAM.
“By engaging the primary care team throughout a patient’s cancer journey and ensuring that all members of a patient’s care team are activated, we can help patients live longer and healthier lives,” said Zullig, who is an associate professor in population health sciences.
The study, which runs for 18 months in the form of a multi-stage trial with the same participants throughout uses a Sequential Multiple Assignment Randomised Trial—or SMART—format with the goal of informing an adaptive intervention design that encourages them to manage their own health.
To date, approximately 100 participants have enrolled at cancer centres and clinics around the United States and benefitted from specific communications between the oncology and primary care teams. For example, if a patient is put on a chemotherapy drug that heightens blood pressure, a semi-automated message is sent to the primary care team to continue monitoring and managing their blood pressure.
What makes this study novel is that beyond their typical cancer care, patients also access videos that give them the knowledge and skills to feel more confident about taking care of their own health.
The videos were created in consultation with Oeffinger, who is a family physician, and experts in patient-reported outcomes, behavioral psychology, implementation science and cancer providers. And because different cancers can target different populations, two cancer groups ensured that the actors in the videos were fully representative.
These patient education videos are distributed to the participants in two stages in accordance with their randomisation. In the initial stage, the videos are standardized and focus on the importance of managing comorbidities, like how to lower blood pressure, increase energy levels and manage blood sugar. And in the second stage, an intensified set of tailored videos, which are also self-guided, enable participants to discuss setting and reaching personal goals where they “choose their own adventure”. Based on their self-reported readiness to change, they also receive a targeted ending.
Throughout, participants’ Hemoglobin A1C (a measure of diabetes control), cholesterol panel and blood pressure are tracked. Additionally, as part of the SMART trial design, ONE TEAM also considers quality of care delivered at the clinic level based on the Healthcare Effectiveness Data and Information Set or HEDIS, a national measure of quality care. Accordingly, if 90 per cent of the patients at a clinic don’t meet the HEDIS measures, then all trial participants at that clinic either remain on the initial stage video set or are titrated up to the tailored series at around 12 months.
Participants also benefit from synchronous webinars moderated by Zullig where they can ask questions of a panel comprising an oncologist, primary care provider and a cancer survivor—each of whom answers from their perspective.
Those unable to attend the webinar receive a recording in the mail by USB drive or disc, or online over a streaming service.
Zullig said ONE TEAM has the potential for implementation in health care systems, uses relatively few resources, could be easily scalable, and is readily implemented. It is also perfectly suited to how people want to receive aspects of their care and how providers can deliver it.
Although the intent of ONE TEAM seems obvious, many have questioned why it’s never been done before.
“To create meaningful change in care delivery for cancer survivors, it is crucial that we develop and test interventions that not only have a meaningful impact on one’s well-being, but also have the potential for use in real world settings. The beauty of ONE TEAM is in the relative simplicity of the content and its potential deliverability using available resources in a healthcare system.”
Associate Prof Leah Zullig
The investigators expect the full dataset for the ONE TEAM study to come in by April 2025.