Steps to Success: Improving Advanced Prostate Cancer Patient Management and Care Coordination
By: David F. Penson, MD, MPH | Posted on: 03 Sep 2021
Prostate cancer is the most commonly diagnosed solid organ malignancy for men in the United States and remains the second leading cause of cancer deaths for this population.1 Clinical advancement through the advent of combination therapies has resulted in a renaissance in the entire landscape for clinicians caring for men with advanced prostate cancer (APC). While offering significant survival benefits, such therapeutic development also renders clinical decision making and the treatment environment itself increasingly complicated.
It is with such considerations in place that the American Urological Association collaborated with Pfizer Oncology to create the Steps to Success toolkit, the result of a process improvement project to study APC patient management and identify key practices to improve patient care coordination.2 The AUA and Pfizer Oncology jointly developed and fielded a survey of health care providers to assess current practice patterns in various care settings. Survey queries touched on areas including demographics, patient monitoring, practice management, and quality and data/analytics. The survey results provided valuable insight into current APC practice dynamics. While a number of best practices were recognized, areas of need were also identified and may serve as important focal points for future quality improvement efforts. Results of this survey can be found in figures 1 and 2.
Following analysis of survey results, best practices were explored through one-on-one interviews with survey participants. It is through this further qualitative research that the AUA identified 3 practice sites of varying size and patient demographics to serve as subjects of in-depth case studies presenting common elements that allowed each site to build their programs to successfully care for patients with APC:
- Arkansas Urology, Little Rock, Arkansas
- OU Health Stephenson Cancer Center, Oklahoma City, Oklahoma
- Tennessee Urology, Knoxville, Tennessee
While each of the sites participating in the case study series had unique aspects to their programs, they also shared common elements that allowed them to make significant and meaningful progress with APC patient care. Quality improvement is a continual process, and each of the programs highlighted in the case study series noted ongoing work on this front and recognized the importance of process review and implementation of change based on patient needs. Based on the experiences of the highlighted programs, several best practices emerged:
- Start with leadership and a commitment to delivering high-quality, evidence-based care.
- Establish a multidisciplinary care team and define roles and responsibilities of team members.
- Identify and collect information on key measures of care and solicit patient feedback.
- Incorporate supportive care as necessary to provide a holistic care model.
- Provide education to patients and family members.
- Use technology to support clinical work and patient care.
Implementation of the best practices identified in the case study series may look different for each APC clinic given constraints due to practice size, patient population and available resources; however, the examples provided may serve as beneficial starting points that can be tailored to the individual needs of each program. Many practices may find that they already possess important tools that can aid in quality improvement efforts. While there is no one-size-fits-all model for every program, the Steps to Success toolkit may serve as a valuable roadmap for others who are thinking about implementing an APC program or looking for guidance on how to improve the care of their patients.
To access the complete toolkit and further explore means for program improvement, please visit the AUA Quality Improvement Resource Library at https://www.auanet.org/practice-resources/patient-safety-and-quality-of-care/quality-improvement-resource-library.
The AUA and Pfizer Oncology would like to sincerely thank Michael S. Cookson, MD, MMHC; E. Scot Davis; Kelly L. Stratton, MD; and Sylvia Waters, RN for their participation in the case study series and the valuable discussion that aided in the development of this toolkit.
- Siegel RL, Miller KD and Jemal A: Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7.
- American Urological Association and Pfizer Oncology: Steps to Success: Improving Advanced Prostate Cancer Patient Management and Care Coordination. Linthicum, Maryland: American Urological Association 2021. Available at https://www.auanet.org/documents/practices-resources/quality/quality-improvement-library/Steps%20to%20Success%20Improving%20Advanced%20PCa%20Patient%20Management%20and%20Care%20Coordination.pdf.