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Interdisciplinary Interventions That Improve Patient-reported Outcomes in Perioperative Cancer Care: a Systematic Review of Randomized Control Trials

Bhagvat J. Maheta, Nainwant K. Singh, Karl A. Lorenz, Sarina Fereydooni, Sydney M. Dy, Hong-nei Wong, Jonathan Bergman, John T. Leppert, Karleen F. Giannitrapani

Abstract

Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer.

Introduction

Teams play an important role in fostering better care for patients with serious conditions or when treatment is complex [1]. A team can be either bounded, where members have static, defined roles, or dynamic, where members adjust roles continuously based on the task [2, 3]. Traditionally, nurses and physicians had their own individual roles when treating patients, and their responsibilities did not overlap or change frequently while treating a patient [2]. The dynamic model of teaming is important in healthcare due to the dynamic nature of patient disease trajectories and medical care generally, allowing different members of the healthcare team to adjust their roles as needed to best take care of the patient [4, 5].

Materials and method

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement and EQUATOR guidelines to guide the creation of this protocol [21, 22]. We registered this study protocol to the PROSPERO database under the registration number CRD42021270688 [23]. We aimed to identify the structures and processes in interdisciplinary interventions that improve perioperative PROs in randomized controlled trials for patients with cancer. For this paper, we define the non-physician clinical team members as advanced practice providers, clinical nurse specialists, and registered nurses.

Results

In total, 8,020 titles/abstracts were screened based on the inclusion and exclusion criteria. 472 full-text articles were then screened for eligibility as shown by Fig 1. We included 34 total studies in our review [40–73], of which 31 reported a clinically meaningful improvement in at least one PRO [40, 42–44, 46–58, 60–73]. The included articles are summarized in Table 2 and Appendix S4 (S1 File). The studies reported 15 different PROs, as shown in Appendix S5 (S1 File). Appendix S5 (S1 File)also provides the ranges for the included PROs that determine MCID based on the most recent published data available.

Discussion

Multiple randomized controlled trials have evaluated the effect of interdisciplinary team interventions on PROs in the perioperative period, however, the studies have notable heterogeneity. Since no included articles had an overall high risk of bias, all studies were of high quality and thus minimize potential bias in the conclusions drawn from this systematic review. Among the RCTs included, there were common intervention components that might drive a positive clinical effect in PROs.

Conclusions

By broadening the definition of teamwork to include teaming, we were able to build upon the current knowledge of team-based interventions, particularly for improving PROs in perioperative cancer care. Our review demonstrated common structures and processes across interventions that impacted PROs in the perioperative period. These included expanding the roles of any clinical team members (advanced practice providers, nurse practitioners, or registered nurses) to include either group education, patient/caregiver education or clinical follow-up since they all demonstrated improved PROs.

Citation: Maheta BJ, Singh NK, Lorenz KA, Fereydooni S, Dy SM, Wong H-n, et al. (2023) Interdisciplinary interventions that improve patient-reported outcomes in perioperative cancer care: A systematic review of randomized control trials. PLoS ONE 18(11): e0294599. https://doi.org/10.1371/journal.pone.0294599

Editor: Sunil Shrestha, Universiti Monash Malaysia: Monash University Malaysia, MALAYSIA

Received: May 29, 2023; Accepted: November 4, 2023; Published: November 20, 2023

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: Dr. Karleen Giannitrapani is supported by a VA Career Development Award (19-075). The full name of the funder is the Veterans Affairs and this is the link to the funder website: https://www.research.va.gov/funding/cdp.cfm. Dr. Nainwant Singh is supported by an Advanced Fellowship in Health Services Research sponsored by the Elizabeth Dole Center of Excellence and VA Center for Innovation to Implementation. The full name of the funder is the Veterans Affairs and this is the link to the funder website: https://www.hsrd.research.va.gov/centers/dole/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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