Patient-centered care in radiation oncology could improve value

Radiation oncology can use non-technological advances within patient-centered care and shared decision making to support “high quality, high value” care while also enhancing and changing clinical trials on cancer treatments, according to a study published in the Journal of American College of Radiology.

Led by Abigail T. Berman, an assistant professor of clinical oncology at the University of Pennsylvania, the study said radiation oncology has historically been more focused on individual patients. It could be the non-technological advancements, however, which are most valuable to patient satisfaction and better outcomes.

“Shared decision making (SDM), with or without the use of clinical decision aids (DAs), holds the promise of providing the degree of personalization and patient-centered care for patients in their journey toward discovering the most appropriate radiation treatment plan, including whether radiation is at all appropriate or the modality used,” Berman and her coauthors wrote. “In addition, outcomes research in radiation oncology is increasingly moving to a patient-centered era, with the incorporation of patient-reported adverse events as preeminent end points.”

Even though SDM has existed in a defined form since 1999, there remain constraints on its use—namely, physicians not having enough time to spend with patients. There’s also been difficultly in distinguishing the technique from regular office visits for measuring its impact, if, like most physician groups, a DA isn’t being used.

Using DAs and SDM and being able to measure their effectiveness will require some technological advancement from electronic health record vendors, the study said.

“As the informatics infrastructure accommodates the use of DAs, it will be critical to embed their use into clinical pathways. Centers that have successfully integrated DAs into the electronic medical record requires desire and interest by key members of any multidisciplinary group, dissemination to all members, and feedback and accountability on system use and performance, based on either “peer pressure” or financial-based incentive,” Berman and her coauthors wrote.

The use of SMD, DAs and patient-centered care can also help clinical trials. The number of research programs evaluating their effectiveness has been increasing while there’s also been wider adoption of patient-report outcomes (PROs), allowing an extra level of comparison of treatments when traditional clinical outcomes find no significant difference.

Overall, the study concluded these patient-centered approaches are a top priority throughout radiation oncology—so much so that insurers are taking notice.

“Insurers, beyond starting to think about how to compensate appropriately for high-quality, patient-centered care, are considering how to specifically reimburse for the resources required to build DAs and participate in validated SDM,” Berman and her coauthors wrote.