4.4.1 Implications for future CME
Education and activities around monitoring and management of side effects, as detailed in Practice Gaps #1 and #2, would be valuable in addressing compliance issues.
Continuing education for the management of geriatric patients with cancer should address clinician competencies in communication and patient education, ensuring that patients and healthcare providers have concordant treatment goals and expectations. Means of overcoming barriers to effective communication with geriatric patients and/or their caregivers must be covered. Suggested approaches to education include integration of patient and/or caregiver perspectives into clinical cases and an emphasis on a multidisciplinary team approach to disease management, including the incorporation of nurse navigators or case managers.
While most likely not appropriate as an individual topic for CME content, potential patient access challenges, including the financial implications of therapies, should be covered in educational activities.
4.5 Practice Performance Gap #4: Engaging in effective communication with patients’ primary care provider
A lack of quality 2-way communication between clinicians treating cancer and their patients’ primary care providers was identified as a major gap in the geriatric setting. As a medical oncologist stated:
“Oncologists…tend to take over the care, and the primary care doctor will participate, but often will cede. And so then we end up writing blood pressure medicines and other things…They’re seeing you so often they don’t keep their primary care appointment. And then we screw up some things.”
Clinicians recognize the significant need to improve communication with primary care physicians, with “Collaborate with the multidisciplinary team (including primary care) about the care of the geriatric patient” second, only behind “Determine optimal treatment,” in the perceived need for competency. It’s often easy for medical oncologists to unintentionally leave primary care physicians out of their communications. Other members of the multidisciplinary team, such as the nursing staff, typically work with the medical oncologist in the same clinic and regularly schedule meetings with others, such as surgeons or radiologists. This type of regular communication rarely occurs with primary care physicians.
Not only do medical oncologists find themselves unwittingly administering primary care, primary care physicians also find themselves faced with managing the effects of therapy administered by medical oncologists. Primary care clinicians report that patients often see them to manage cancer-treatment related side effects, or to ask questions about the treatment they are undergoing. Without communication from the medical oncologist, the primary care physician is ill-equipped to address these issues.
With effective, 2-way communication between medical oncologists, geriatricians, and primary care physicians, a continuum of care is established that provides better support for patients and may possibly improve clinical outcomes.