Improving the Provision of Cancer Care: The Need for Integrating Human Factors
TimeTuesday, April 133:30pm - 3:50pm EDT
LocationPatient Safety Research and Initiatives
Over half a million cancer patients die annually within the United States alone (CDC, 2020), despite cutting edge research and treatment options. Additionally, there is an expected uptick in cancer diagnoses and at higher stages due to delays (preventive, diagnostic) during the pandemic, making this topic extremely timely. Consequently, there is an urgent need to address the consequences of delayed diagnoses that will emerge across time, as well as consider the impact on the healthcare system at large (e.g. will the system be overwhelmed with cancer cases?). Even prior to the pandemic, cancer care has already suffered from legal and regulatory challenges, incompatible financial incentives, overuse and misuse of resources, and mismatched expectations of patients and providers. Such obstacles result in undesirable consequences that negatively affect, clinicians, patients, and families. Indeed, the State of Cancer Care (2020) report indicated that there are serious concerns regarding the limitations and effectiveness of electronic health records, considerations for outcomes ranging from clinical to quality of life and mental health for patients, challenges associated with timeliness of clinical care, and the burnout plaguing clinicians, among others. With such a multitude of obstacles that can result in potentially significant consequences, there is a need for a systematic approach to improvement. As such, there is a need for human factors to be embedded within the entire domain of cancer care. Therefore, the objective of this presentation is to garner discussion by introducing and describing some existing issues within cancer care that could benefit from the science and application of human factors. Specifically, this presentation will highlight issues related to the people, technologies, and processes inherent within cancer care by offering a patient case to highlight the relevance of human factors within the clinical context. Our patient case will describe a complex patient undergoing treatment for cancer while managing other comorbidities (diabetes and hypertension). We will highlight decision points that necessitate coordination between the patient care team as well as aspects of the patient’s life context that contribute to challenges to treatment adherence. We will analyze the case using the factors and constructs described in the next section.
Human Factors and Cancer Care
The provision of cancer care involves individuals relying on technologies to enact processes within a variety of contexts. That is, cancer care entails the clinical context, but it also includes the contexts of daily living (e.g., home, work, and transportation). Cancer care, like any other systems takes place within the intersection of individuals, technologies, and processes. This presentation will talk about them orthogonally and within the clinical context for simplicity.
People. The ‘people’ within cancer care refers to all people encompassed within the provision of care (e.g., administrators, researchers, clinicians, and ancillary staff). The ‘people’ component also refers to patients and families since they are active participants in their care. All must work both independently and together as a team to facilitate effective and patient-centered care. The interdependent interactions among care team members are often known as care coordination. There is a need to consider coordination not just within the cancer care team but also with the patient and family. “Care coordination synchronizes the delivery of a patient’s health care from multiple providers and specialists” (NJEM Catalyst, 2018, p. 1). Poor care coordination can impact trust and result in poor symptom control, negative outcomes, and even medical errors (Weaver & Jacobsen, 2018). Meta-analytic evidence suggests that care coordination approaches lead to significant improvements in screening, patient experience, treatments, and the quality of end-of-life (Gorin et al., 2017). Human factors can aid in the development, implementation, and evaluation of care coordination efforts.
Tools and Technologies. This category refers to any support solutions that are present or are needed to facilitate the work of the clinicians and the patients. Clearly, there is a wealth of technological advances involved in the administration of cancer care, and unquestionably, all of those technologies should have human-centered design. However, given that cancer care is a complex endeavor that consists of many dynamic elements, technologies are often inadequate or inappropriate. Consequently, human factors is crucial at the design end of spectrum, but it is also critical at the implementation end of the spectrum. As one technological example, telemedicine has become increasingly prevalent in recent years, but the pandemic has mandated many providers leverage telemedicine in novel yet unexpected ways due to shortages in resources and governmental regulations. For instance, telemedicine is now being employed as a means to deliver bad news. The delivery of bad news is more than simply information exchange; it is a multifaceted task (Rosenzweig et al., 2012). Bad news requires thoughtful nonverbal communication (e.g., body language and gestures), emotion management, empathy, shared mental models, competence, and proper closures (Alewani & Ahmed, 204; Monden et al., 2016). As such, human factors can assist with improving this process (e.g., identifying appropriate technologies, creating a toolkit to strengthen the necessary knowledge, skills, and attitudes, and establishing metrics to determine if the effectiveness of the process).
Processes. The ‘processes’ within cancer refer to the actions performed by the individuals to execute the care. Cancer is a complex disease that often necessitates a tailored approach specific to cancer type, sub-type, and each patient. Many processes are at play by individuals in multiple roles, specialties, and potentially even institutions. Schedule management all of these tasks becomes a logistical process all on its own. This scheduling management process becomes challenging because of the resource deficiencies (e.g., nursing shortages, lack of beds, and unavailable pharmacists) as well as variability in patient needs and treatment plans (Heshmat & Eltawil, 2019). Mishandled scheduling can result in adverse health outcomes and delayed diagnoses (Marynissen & Demeulesmeester, 2019) as well as excessive wait times, frustration and dissatisfaction (Kallen et al., 2016). Such poor scheduling results in many people experiencing potentially significantly negative outcomes, therefore, making it a noteworthy problem. Human factors can assist in fostering better scheduling by investigating and improving the workload of providers, enhancing the allocation of resources, and streamlining the various individual steps involved in scheduling to increase efficiency. The patient perspective should be elicited and considered including the challenges associated with logistics within the context of the patient’s life.
Cancer care involves numerous individuals leveraging technologies to enact processes within a context. Depending on a variety of factors (e.g., cancer type) and sub-type, the course of cancer care may be complex and lengthy, creating a multitude of opportunities for the patients and their care to fall through the cracks. Thus, much work is needed to investigate topics traditionally addressed by human factors – care coordination and information exchange, use of patient- and clinician-facing technologies such as telehealth, and others. Human factors has scientific underpinnings as well as tools and techniques that can ultimately strengthen cancer care. We hope that this presentation will serve as a catalyst to begin a discussion on how human factors can become more intimately involved as the relationship between human factors and cancer care has gone largely unexplored.