Models of Care Toolkit
Multidisciplinary clinics
Multidisciplinary clinics use an integrated approach to the planning and delivery of cancer services. These clinics are run within a single cancer centre and are usually comprised of multiple departments or programs (e.g., radiation or medical oncology, pharmacy, psychology) and individual team members.
A key aspect of these models is the overarching administrative structure that focuses on the integration and coordination of clinical services. It is this aspect of multidisciplinary clinics that uniquely supports person-centred care as all services are coordinated around the needs of the patient, as opposed to the schedules of each separate discipline involved in cancer care.
A care coordinator, the development of clear communication and coordination frameworks are crucial to the implementation especially in instances where specialized care is delivered concurrently.3
Evidence suggests that organizing care using a multidisciplinary clinic approach increases patient satisfaction and the efficiency of care delivery. The model reduces the need to transition patients between care providers and the duplication of services such as testing. It also helps patients access complementary care from dietitians, speech language pathologists and psychologists in a timely manner.3
As with the network model, multidisciplinary clinics require multi-level governance processes that consider the capacity and capability of professions involved. Administrative challenges such as remuneration frameworks, schedule coordination and space allocation require careful consideration and may be a limiting factor to success.
Building a person-centred care team
To be truly person-centred, care teams should include all disciplines involved in a patient’s care. This includes oncologist experts such as radiation oncologists, medical oncologists and surgeons and also radiologists, pathologists, pharmacists, palliative care specialists and nurses. Allied care professionals such as psychologists, social workers, dietitians and patient navigators ensure that patients receive access to the services they need, when they need it. While not evident in all clinic models, the addition of primary health care shows to significantly enhance connected care. Learn more about coordinating with primary care.
The Saskatchewan Cancer Agency established provincial disease site group (DSG) clinics to provide multidisciplinary disease site care for patients from initial consultation through follow-up care. The model integrates the existing DSG tumour board and rounds ensuring care is delivered following best practice guidelines.
The DSG framework has been created for lung, breast, gastrointestinal, genitourinary, gynecological and hematologic cancer and a clinic has been established for gastrointestinal cancer.
To ensure equitable access to care for patients living in rural and remote areas, the clinic has capacity to support patients in person and virtually. The program’s patient navigator program is also being expanded to include culturally appropriate navigation to enhance the use of services within First Nations and Métis communities.11
While the model is still being established and evaluation is pending, the Saskatchewan Cancer Agency has noted the following benefits:
- An enhanced approach to patient-centred care
- A more collaborative approach to patient management and the ability to address patient and family medical and support questions
- Fewer patient visits to the clinic due to the coordinated approach to appointment scheduling
- Improved decision-making by providers due to the interdisciplinary approach to care planning
- More efficient workflow including investigations, referrals, and treatment coordination
- Decreased time to treatment
Connect with Saskatchewan Cancer Agency’s model lead.
Management of hematological malignancies, such as leukemia, lymphoma and myeloma, is complex and requires interdisciplinary involvement in planning. Because treatment can last years, finding ways to support the long-term needs of patients is important.
As part of a quality improvement initiative, Ontario Health’s Cancer Care Ontario reviewed the roles of multidisciplinary teams involved in the care of this patient population. They used this review to support changes that optimize the role of registered nurses, nurse practitioners and physician assistants. Oversight for planning, care and follow-up is provided by hematologists, oncologists and/or transplant physicians.
When fully implemented, the model will:
- Ensure that health-care team members can work to their full scope of practice
- Provide outpatient care for eligible patients, shifting the burden from resource-intensive in-patient services
- Support collaboration among health-care team members, better balancing workload
- Ensure patients have timely access to high quality care and as close to home as possible
- Advance service delivery and expand capacity for future patients
- Optimize the use of health-care resources
While specific to malignant hematology, this model could be extended to other patient populations with complex needs.
Ontario’s Complex Malignant Hematology model also expands the scope of practice for nurses and other health care team members. Learn more about optimizing scope of practice.
Learn more about Ontario’s Complex Malignant Hematology program.12
- Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ. 2016;188(17-18):E474-E483.
- Riley-Behringer M, Davis MM, Werner JJ, Fagnan LJ, Stange KC. The evolving collaborative relationship between Practice-based Research Networks (PBRNs) and clinical and translational science awardees (CTSAs). J Clin Transl Sci. 2017;1(5):301-309.
- Stone CJL, Vaid HM, Selvam R, Ashworth A, Robinson A, Digby GC. Multidisciplinary clinics in lung cancer care: A systematic review. Clin Lung Cancer. 2018;19(4):323-330.e3.
- Brown BB, Patel C, McInnes E, Mays N, Young J, Haines M. The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies. BMC Health Serv Res. 2016;16(1).
- Hunter RM, Davie C, Rudd A, et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: A comparative effectiveness before and after model. PLoS One. 2013;8(8):e70420.
- Reeders J, Ashoka Menon V, Mani A, George M. Clinical profiles and survival outcomes of patients with well-differentiated neuroendocrine tumors at a health network in new South Wales, Australia: Retrospective study. JMIR Cancer. 2019;5(2):e12849.
- Tremblay D, Touati N, Roberge D, et al. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implement Sci. 2016;11(1):39.
- Labbe C, Martel S, Fournier B, Saint-Pierre C. P1.15-13 wait times for diagnosis and treatment of lung cancer across the province of Quebec, Canada. J Thorac Oncol. 2018;13(10):S615-S616.
- Ministère de la Santé et des Services sociaux. Cadre de référence pour la mise en place de réseaux par siège tumoral. Accessed December 2, 2021. https://publications.msss.gouv.qc.ca/msss/document-002357
- Canadian Hospice Palliative Care Association. Innovative Models of Integrated Hospice Palliative Care, the Way Forward Initiative: An Integrated Palliative Approach to Care.; 2013. Accessed November 24, 2021. http://www.hpcintegration.ca/media/40546/TWF-innovative-models-report-Eng-webfinal-2.pdf
- Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers’ perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv. Res. 2021;21(1)
- Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d