Uro-genital oncology synergy: Accelerating treatment with multidisciplinary joint counseling clinic

Abstract

Background: Uro-genital oncology patients often face complex treatment decisions requiring multiple consultations, which can delay treatment initiation and lead to fragmented care. Traditional approaches are particularly challenging for patients with multiple treatment options. Multidisciplinary care models have been shown to improve patient outcomes. This project introduces a multidisciplinary joint counseling clinic (MDJCC) to enhance the quality and efficiency of uro-genital oncology care.

Methods: MDJCC was piloted from May 2019 to January 2020, paused during the COVID-19 pandemic, and re-established in September 2023. Outcome measures include the percentage of patients who make final treatment decisions during or shortly after the clinic. Process measures track the number of clinics conducted monthly, and balance measures assess patient satisfaction. The target population comprises post uro-genital oncology multidisciplinary team (MDT) cases requiring surgical, medical, or radiation therapy.

Results: The clinic reduced delays in traditional counseling pathways, enabling most patients to decide on treatment during the same session or within 7 days, compared to the previous 30-day standard. Consolidating disciplines into a single visit optimized resource utilization, reduced costs, and improved patient understanding and satisfaction.

Conclusion: The MDJCC significantly improved care quality, streamlined decision-making, and enhanced patient satisfaction in uro-genital oncology, highlighting its value as a care model.

Graphical abstract

Keywords

healthcare efficiency / joint counseling clinic / multidisciplinary care / treatment decision-making / urology

1 INTRODUCTION

1.1 Statement of the problem

In uro-genital oncology, patients frequently face complex and multifaceted treatment decisions involving surgical, medical, and radiation therapy options. The decision-making process in this domain can be overwhelming due to the sheer number of treatment modalities, each with distinct benefits and risks[1]. Traditionally, patients are required to attend separate consultations with different specialists, leading to fragmented care. This approach not only delays treatment initiation but also causes confusion, inefficiencies, and emotional strain for patients already grappling with a cancer diagnosis[2].

Multiple studies have shown that fragmented care in oncology significantly contributes to delays in treatment decisions, increases the stress on patients and potentially affects clinical outcomes[3]. As patient needs become more complex and involve various disciplines, traditional care pathways that rely on sequential consultations across multiple departments fail to provide the integrated and timely care that patients deserve[4]. Moreover, delays in decision-making may negatively impact patients psychological well-being and overall satisfaction with their care[5].

Recent evidence supports the implementation of multidisciplinary care models, which have been shown to improve the timeliness and quality of decision-making in oncology settings. Studies have indicated that these models, which involve collaboration between specialists in a single session, lead to faster treatment decisions and higher patient satisfaction by consolidating information and reducing the emotional and logistical burden on patients[6]. Also, integrating multidisciplinary teams into the patient care process allows for a more holistic approach, ensuring that all aspects of a patient's treatment options are considered simultaneously, rather than sequentially.

The use of a multidisciplinary joint counseling clinic (MDJCC) in uro-genital oncology offers an innovative solution to the challenges posed by fragmented care. This model, where patients meet with all relevant specialists on one visit, not only accelerates decision-making but also promotes shared decision-making. By discussing treatment options in the presence of all specialists, patients are empowered to make informed decisions based on a comprehensive understanding of their treatment possibilities[7,8]. This integrated approach to care has been shown to improve both clinical outcomes and patient satisfaction by fostering an environment of collaboration and communication between patients and providers[9].

Given the importance of timely treatment initiation and the complexities involved in uro-genital oncology decision-making, the need for innovative care models is increasingly recognized. This quality project aims to establish an MDJCC to streamline the patient journey, reduce treatment delays, and facilitate a shared, informed decision-making process. By bringing together multiple specialists in one setting, the clinic seeks to improve care efficiency, patient satisfaction, and treatment outcomes.

1.2 Access to care: Current state

The current state of access to multidisciplinary uro-genital oncology care reveals several challenges that hinder both the quality and efficiency of patient care. These barriers—spanning from manpower shortages to systemic inefficiencies—can result in delays in diagnosis, fragmented care, and a prolonged treatment journey for patients. Addressing these challenges requires a deep understanding of the various factors contributing to delayed care and decision-making.

1.2.1 Manpower factors

The limited availability of specialized healthcare professionals is a significant contributor to delayed care in uro-genital oncology. This includes a shortage of trained oncologists, radiation therapists, and clinical nurse specialists, all of which increase the time needed to coordinate consultations and treatment plans[4,9]. High workloads and burnout among healthcare providers further exacerbate the issue, leaving insufficient time for personalized treatment planning and follow-up care. As a result, patients may experience delays in receiving timely treatment, affecting both their emotional well-being and clinical outcomes[9].

To mitigate these challenges, strategic investments in workforce training and recruitment are necessary. Increasing the number of trained specialists, while implementing initiatives to address staff burnout, can improve the overall efficiency and responsiveness of uro-genital oncology services. Additionally, leveraging telemedicine platforms to facilitate consultations can help bridge the manpower gap and improve access to care[10].

1.2.2 System/process factors

Traditional referral systems, which require patients to attend multiple separate appointments with each specialty across different facilities, are another significant barrier. This fragmented approach to care increases the administrative burden for both staff and patients. Coordination among departments is often limited, leading to delays in treatment initiation and miscommunication between specialties[11]. As patients navigate through these disjointed processes, they face prolonged waiting times for consultations and decisions, which can detract from their overall care experience and lead to unnecessary stress.

An integrated referral system that utilizes centralized scheduling and shared electronic medical records can streamline the patient journey. By ensuring seamless communication between departments, such a system can minimize delays and improve the quality-of-care coordination[12].

1.2.3 Patient factors

Patient factors, including the understanding of complex treatment options, significantly influence the decision-making process[13]. Patients often struggle to comprehend the intricacies of available treatment modalities, which can lead to indecision, anxiety, or delays in making informed choices[14]. Personal factors such as transportation issues, financial constraints, and scheduling conflicts also play a role in limiting access to care. In addition, patients’ preferences, values, and emotional states can affect their willingness to pursue certain treatment options, creating further complexity in the decision-making process[15].

Addressing these challenges requires a patient-centered approach that incorporates educational sessions, decision aids, and consistent support from healthcare providers. For instance, visual aids and simplified educational materials tailored to the patients’ literacy level can enhance understanding and empower patients to actively participate in their care.

1.2.4 Environmental factors

Environmental challenges, such as clinic schedules, facility resources, and availability of consultation space, also contribute to the inefficiency of the current system. Delays in securing appropriate spaces for consultations, coupled with overcrowded clinic schedules, often force patients to wait for extended periods before they can meet with the necessary specialists[16]. These logistical challenges not only waste valuable time but also hinder the ability to provide cohesive, integrated care, leading to a less-than-optimal patient experience.

Implementing digital tools such as virtual consultation platforms and optimizing clinic workflows can help address these environmental limitations. Redesigning clinic schedules to accommodate multidisciplinary sessions can also enhance the overall efficiency of care delivery.

1.3 Aim

This project introduces the MDJCC, designed to address the barriers identified above by streamlining the consultation process. The clinic allows patients to meet with all relevant specialists—oncologists, surgeons, radiation therapists, and clinical nurse specialists—in a single, comprehensive session. This coordinated approach enables patients to receive guidance tailored to their specific medical history, preferences, and overall health goals, fostering a more collaborative, individualized care experience.

The main aim of this project is to reduce the average time from diagnosis to treatment initiation by 20% within the first 6 months of implementing the MDJCC, thereby reducing the baseline timeline of 30 days. By facilitating shared decision-making and providing a streamlined, team-based approach, the clinic helps patients make well-informed treatment decisions faster, thus improving patient satisfaction, reducing stress, and ultimately enhancing clinical outcomes. This initiative also seeks to reduce the strain on the healthcare system by improving coordination and optimizing resources.

2 METHODS

2.1 Inclusion criteria

All uro-genital oncology patients referred to the multidisciplinary tumor board (MDT) with multiple treatment options, involving surgical, medical, or radiation therapies, are included in this project. Participants must be eligible for and interested in pursuing one or more treatment modalities.

2.2 Exclusion criteria

Patients with single-modality treatment options or those who are unable to attend in-person consultations due to severe health limitations or geographical constraints are excluded from this study.

2.3 Timeline

This study was conducted at the National Center for Cancer Care and Research (NCCCR) with collaboration with uro-genital oncology team at Ambulatory Care Center (ACC). This quality project was initially conducted between May 2019 and January 2020 but was paused due to the COVID-19 pandemic. The MDJCC was re-established in September 2023, following a sustainable model, with data collection planned through May 2024. Each clinic visit involves a multidisciplinary team, including specialists in surgical, medical, and radiation oncology, as well as a lead clinical nurse specialist (CNS). This clinic is facilitated by a uro-genital oncology patient pathway coordinator (PPC), who ensures streamlined coordination of the patient's journey through the clinic. Together, they provide a comprehensive overview of treatment options and facilitate patient-centered, shared decision-making.

2.4 Root cause analysis

Figure 1 illustrates key factors delaying treatment initiation for urogenital patients due to challenges in finalizing decisions. These barriers fall into four domains: people, environment, equipment, and process. Limited patient involvement, resource constraints, outdated scheduling systems, and fragmented communication contribute to delays. Enhancing patient education, streamlining workflows, and integrating technology may help overcome these challenges and improve timely treatment initiation.

Figure 2 summarizes the workflow before implementing the MDJCC, highlighting approximate delays in appointments and patient flow.

2.5 Measures of improvement

In this quality project, a model of improvement was used. In this model, the process measures included the number of clinics held monthly along with the number of patients who received counseling in these clinics. Outcome measures tracked the percentage of patients who made a final decision within 7 days, and balance measures assessed patient satisfaction rates. Additionally, participants’ medical histories and treatment preferences were reviewed to tailor the approach for each patient, with individualized counseling and education on their options.

2.6 Concept change

The MDJCC concept is based on the integration of patient-centered care with coordinated specialist input. By consolidating consultations into a single session, patients receive comprehensive information from all relevant specialties in one visit, facilitated by a uro-genital oncology pathway coordinator. This coordinator plays a critical role in ensuring seamless transitions and clear communication across all disciplines involved. Figure 3 outlines the structured framework of the quality improvement initiative, highlighting the aim, primary and secondary drivers, and specific changes designed to address delays in patient decision-making and optimize the treatment initiation process.

Figure 4 illustrates the optimized workflow following the implementation of the MDJCC, designed to enhance coordination, reduce delays, and facilitate timely patient decision-making and treatment initiation.

3 RESULTS

A total of 89 patients were counseled in the MDJCC during the duration of the study. The clinic successfully reduced the average time for patients to reach a final treatment decision from 30 days to just 7 days. Most patients were able to make their decision during the same clinic visit, highlighting the clinic's effectiveness in providing comprehensive and efficient counseling. Table 1 presents the total number of patients counseled in the MDJCC, along with the number and percentage of patients who made their decision on the same day.

This model facilitated a clearer understanding of treatment options, encouraged active patient engagement in shared decision-making, and expedited final decisions. Additionally, by consolidating consultations, the clinic optimized resource utilization, reduced wait times, and lowered healthcare costs for both patients and the healthcare system.

Patient satisfaction was notably high, with 99% of patients reporting a satisfaction score of 4 or 5 on a five-point scale. The main positive feedback emphasized the benefits of having all specialties available in a single visit, as shown in Table 2.

4 DISCUSSION

The introduction of the MDJCC significantly improved decision-making efficiency for patients with uro-genital cancer, highlighting the advantages of a collaborative, patient-centered approach[17]. By meeting with all relevant specialists in a single setting, patients received coordinated, individualized education based on their medical histories, allowing them to make well-informed treatment decisions quickly, that aligns with the re-commendations and guidelines[18–20]. This model also emphasized shared decision-making, giving patients the time and information needed to consider their options and participate actively in their care.

Beyond patient benefits, this multidisciplinary approach allowed for more efficient resource use, as it reduced the need for separate consultations, saving time and system resources. Studies show that such integrated models of care improve patient satisfaction, adherence, and clinical outcomes[21].

One limitation of this study is its sample size, which was limited due to the clinic's pilot nature and interruptions caused by the COVID-19 pandemic. Furthermore, while patient satisfaction was assessed qualitatively, a standardized patient satisfaction survey could provide more robust data for future studies. Additional research could explore the long-term impact of this model on patient outcomes and healthcare costs.

5 CONCLUSION

The MDJCC has proven to be a valuable model for delivering timely, integrated care for patients with uro-genital cancers. By offering comprehensive, individualized counseling experience in a single visit, the clinic improved patient decision-making efficiency and satisfaction. This model not only reduces decision-making time but also aligns with patient-centered care principles, underscoring the importance of shared decision-making in oncology treatment. Future implementations should explore expanding this model across other oncology specialties to optimize care further.

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