Evaluation Results
4R Oncology Impact on Clinicians and People with Cancer
4R improves clinicians’ effectiveness in patient-facing care planning
In a survey of clinicians across 8 institutions (4 academic, 4 community), Baseline (pre-4R) cohort N=66; post-intervention (4R) cohort N=62.
4R significantly improved effectiveness of patient-facing care planning.
- Ability to provide patients with personalized care plans (50%, 90%, p<0.001)
- Ability to include multiple aspects of care in care plans (41%, 66%, p=0.001)
- Ability to conducts effective discussions of care plans with patients (22%, 77%, p<=0.001)
- Enable patients to effectively manage their care across specialties (32%, 61%, p-0.001)
- Enable my practice to effectively work with other specialties (49%, 88%, p<0.001)
Trosman et al JCO 2022, suppl 16,abstr 1542
4R improves patient self-management and delivery of interdependent care
In a survey of people with cancer across 10 institutions (5 safety-net, 5 non-safety-net), Intervention cohort: N=422 patients; Historical control cohort: N=466 patients.
There was a significant improvement in patient self-management vs control, e.g. Ability to organize, manage care (78.9%, 72.1%, p=0.02).
There were also significant improvements in delivery of interdependent care:
- Fertility consult prior to systemic therapy (58%, 31.8%, p<0.05)
- PCP consult prior to treatment (44%, 65%, p<0.01)
- Flu vaccination prior to treatment (53%, 68%, p<0,05)
Trosman et al JCO OP 2021
%
Clinicians reported 4R useful for care planning and management
%
Clinicians reported decrease in post-visit inquiries
%
Patients found Care Sequences Useful
%
Patient reported ability to self manage
Used 4R for a high functioning team Liu R, et al JCO OP 2022
Formed team
We formed a virtual multidisciplinary team of 24 specialties who assumed team responsibilities for relevant care;
Shared Goal
All participants committed to a shared goal of delivering interdependent care at the optimal time and sequence using 4R Care Sequence content as the basis
40 Quality Improvements
The team conducted 40 quality improvements / optimizations in breast and lung cancer to enable effective interdependent care, 50% of which entailed low level of effort, and 78% resulted in improved care process efficiency.
Ongoing Teamwork
An ongoing teamwork adaptation process was established to continue to make improvements and optimizations to care.
Publications
Dunne W et al. A Learning Health System Approach to Cancer Survivorship Care Among LGBTQ+ Communities. JCO Oncol Pract. 2023 Jan;19(1):e103-e114. doi:
Liu, et al. Fostering a high-functioning team in cancer care using the 4R Oncology model: assessment in a large health system and a blueprint for other institutions. JCO Oncol Pract. 2023 Jan;19(1):e125-e137.
Ossowski et al. Improving Time to Molecular Testing Results in Patients With Newly Diagnosed, Metastatic Non-Small-Cell Lung Cancer. JCO Oncol Pract. 2022 Nov;18(11)
Ossowski et al. Increasing Advance Directive Completion within the 4R Oncology Model in Breast Cancer Patients Prior to Surgery in a Racially Diverse Patient Population. The Permanente Journal. In press.
Simon et al. Systematic Patient Navigation Strategies to Scale Breast Cancer Disparity Reduction by Improved Cancer Prevention and Care Delivery Processes. JCO Oncol Pract. 2020 Dec;16(12):e1462-e1470.
Trosman E al. Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers? J Clin Oncol 37, 2019 (suppl; abstr 6601)
Trosman et al. Results from a pilot of an innovative 4R Cancer Care Delivery Model: Impact on patient self-management. J Clin Oncol 36, 2018 (suppl; abstr 6527).
Trosman JR, Carlos RC, Simon MA et al. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery. J Oncol Pract. 2016 Aug 30. pii: JOPR013573.
Trosman JR, Weldon CB, Perez CB et al. Written care plan and patient enablement: Pre-implementation data from the 4R in Oncology Project. J Clin Oncol 35, 2017 (suppl 8S; abstract 55).
Trosman JT, Weldon CB. Models on Care Delivery. Chapter 17. Editors: Al Benson III, MD, A Chakravarthy, MD, Stanley Hamilton, MD. Cancers of the Colon and Rectum. A Multidisciplinary Approach to Diagnosis and Management Series. 288 pages Hardback. ISBN13 9781936287581
Trosman, et al. Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non-Safety-Net Centers. JCO Oncol Pract, 2021
Weldon CB, Friedewald SM, Kulkarni SA, Simon MA, Carlos RC, Strauss JB, Bunce, MM, Small A, Trosman, JR. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient’s Breast Cancer Care Initiation. J Am Coll Radiol. 2016 Dec;13(12 Pt B):1579-1589.
Weldon CB, Trosman JR, Gradishar WJ, Benson AB, Schink JC. Barriers to the Use of Personalized Medicine in Breast Cancer. Journal of Oncology Practice. 2012;8(4):24e-31e.
Weldon CB, Trosman JR, Makower DF, Rapkin BD, Perez CB, Kulkarni S, Schaeffer SM, Hoskins K, Gallagher C, Lo SS, Grace-Louthen C, Throckmorton A, Krueger E, Van Horn J, Reaves BC, Ravelo A, Yu E, Benson AB, Schapira L, Gradishar WJ. 4R Program results in breast cancer: the impact of 4R Care Delivery Model on timing and sequence of guideline recommended care. J Clin Oncol 38: 2020 (suppl; abstr 573). DOI: 10.1200/JCO.2020.38.15_suppl.573
Weldon CB, Trosman JR, Perez CB et al. How well is interdependent care managed across specialties in breast cancer? Metrics and pre-implementation data from the 4R in Oncology Project. J Clin Oncol 35, 2017 (suppl 8S; abstract 171).
Weldon CB, Trosman JR, Schink JC. Cost of Cancer: There Is More to It Than Containing Chemotherapy Costs. Oncology. 2012, Vol. 26No. 11
Weldon et al. Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers? J Clin Oncol 37, 2019 (suppl; abstr 562)
Weldon et al. Results from a pilot of an innovative 4R Cancer Care Delivery Model in early breast cancer: Impact on timing and sequencing of guideline recommended care. J Clin Oncol 36, 2018 (suppl; abstr 561).