The Cancer Supportive Care Model

A Patient-Partnered Paradigm Shift in Health Care Delivery

Elias Anaissie, MD; Tara Mink, RN

J Participat Med. 2011;3

Impact

Superior Patient Outcomes

The development and implementation of the Supportive Care Model have shown that therapy for MM can be safely delivered using this strategy. Indeed, the outcome of patients with MM treated at the MIRT has been consistently shown to produce superior outcomes in terms of patient survival and disease control.^{[9 12 13]}

Independent Evaluation

An independent data analysis conducted by the University HealthSystem Consortium in January 2010 concluded that MIRT is the national leader in the paradigm shift from an inpatient to an outpatient model of care, and in which patient participation is strongly emphasized. "We have been able to find out that Arkansas' program is truly unique. Arkansas' percentage of bone marrow transplant (BMT) outpatients is the highest by far [see Figure 3]. In addition, because you are unique, UHC's models do not give you the credit you deserve for the severity of your inpatients.^[14]

(Enlarge Image)

Figure 3.

Percentage of MIRT Outpatients Requiring BMT.

This patient-clinician partnership has been well received by patients, their caregivers, and the treatment team because it fosters patient empowerment and active participation in the decision process throughout therapy. The Cancer Supportive Care model continues to be actively used at MIRT and the authors believe this model can be easily and safely expanded beyond the elderly population with cancer to other patient populations. Shifting patient care from the inpatient to the outpatient setting is expected to improve the overall patient experience by fostering patient empowerment, comfort, convenience, reduction in length of hospitalization and decreased overall cost to the patient and provider.

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Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.

Table 1. Patient and Caregiver Participation: The Focus of the MIRT Approach to Care Delivery.
Partnership in care management: Focus on caregiver involvement (family and friends) Participation in treatment decisions, including the location of care (hospital or outpatient unit) and review of the outcome of similarly treated patients Open access to patient's own medical records including instant and secure online access to test results Review of patient diaries with clinicians Self-administration of intravenous and subcutaneous medications Partnership in the quality of care through a patient-initiated quality improvement program Education of patients and caregivers using various resource centers Facilitating patient and caregiver networking through support groups with a focus on spirituality, sharing experiences and others Providing access [24/7/365] to the services of our clinicians including when patients are under the care of their local physician outside MIRT

Table 2. Patient – Partnered Care: Benefits of Outpatient Therapy vs Hospitalization.
	HOSPITAL	OUTPATIENT	COMMENTS
PATIENT DIGNITY
Response to calls for help, toileting needs, pain control, others.	Not always timely, especially with staff shortages.	Timelier when provided by loved ones	Feelings of powerlessness often accompany illness and hospitalization especially among patients with life-threatening conditions such as cancer. These feelings are exacerbated. when patients feel that their basic needs are unmet leaving them with a feeling of loss of dignity.
Dress code	Open back gowns do not preserve dignity.	Patients may dress as they wish.
PATIENT EMPOWERMENT
Control over their living environment	Loss with interruptions by various hospital personnel day and night	Mostly preserved. Patients have flexibility in scheduling to the outpatient visits according to their daily routine.	Control over one's schedule empowers and encourages the patient to take responsibility in scheduling the delivery of their care.
Self-medication	No	Yes	Self-administration of subcutaneous and intravenous medications allows patients to take ownership of their care.
SOCIAL SUPPORT
Family & friends	Disrupted because of limitations on visitation hours	Preserved; friends and family available at all times-as needed	Cancer patients experience feelings of anxiety and fear about their outcome. Hence, social support is a critical component of healing, particularly with current staff shortages. Caregiver involvement in and understanding of the care requirements for their loved ones ensures better understanding of and compliance with treatment plans after the patient returns home.
HEALTH CARE ENVIRONMENT
Food quality	Variable	Better, according to patient preferences	The health care environment can have a significant effect on patient satisfaction and experience. A quieter, friendlier, and personalized environment is more conductive to healing. Physical activity, good nutrition, and emotional wellbeing are critical for the successful outcomes of patients with cancer.
Noise level	High	Low
Physical and social environment	Unfriendly; hospitals have plain furniture, bland colors etc.	Usually friendlier; patients stay in their own home with their loved ones and pets can experience the outdoors, etc.
Physical activity	Limited because of space confinement	Enhanced because patients can move as needed, hence decreasing the risk of muscle disuse atrophy
Emotional well being	Affected because of space confinement, noise level, loss of control over activities including rest/sleep, etc.	Mostly preserved. Patients are free to go where they want, engage in social, cultural and or business activities, etc.
PATIENT SAFETY
Risk for cross infections and medication errors	Significant risk especially with staff shortages, overworked physician trainees, other	Reduced risk because of lack of exposure to iatrogenic conditions	Hospital – associated complications are a significant cause of morbidity and mortality [10]
LIMITATIONS OF OUTPATIENT THERAPY
24-hours nursing and physician care	Immediately available	Requires appointment or visit to emergency room
Burden on caregivers	Limited	Extensive	Some patients prefer hospitalization rather than putting excessive burden on their loved ones

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The Cancer Supportive Care Model

A Patient-Partnered Paradigm Shift in Health Care Delivery

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