1 00:00:05,873 --> 00:00:11,812 GOOD MORNING EVERYONE, THIS 2 00:00:11,812 --> 00:00:13,547 IS KELVIN CHOI, DIRECTOR OF 3 00:00:13,547 --> 00:00:15,449 THE DIVISION OF. 4 00:00:15,449 --> 00:00:15,916 [INDISCERNIBLE] 5 00:00:15,916 --> 00:00:22,089 WELCOME TO THE SEMINAR 6 00:00:22,089 --> 00:00:24,725 NOVEMBER EDITION HOPE YOU HAD 7 00:00:24,725 --> 00:00:27,895 AN ENJOYABLE HALLOWEEN AND 8 00:00:27,895 --> 00:00:29,497 ALSO HAPPY VETERAN DAYS. 9 00:00:29,497 --> 00:00:39,974 TODAY WE THE COLLEGE OF 10 00:00:45,146 --> 00:00:55,456 PUBLIC HEALTH AT THE 11 00:00:56,624 --> 00:00:59,160 UNIVERSITY OF NEBRASKA CENTER. 12 00:00:59,160 --> 00:01:09,470 HER DYNAMICS 13 00:01:17,578 --> 00:01:21,816 AND SHARING DYNAMICS OF THE 14 00:01:21,816 --> 00:01:23,684 INSTITUTE WHERE SHE WAS 15 00:01:23,684 --> 00:01:26,987 WORKING BEFORE. 16 00:01:26,987 --> 00:01:29,757 SHE CONDUCTED THE ANALYSIS OF 17 00:01:29,757 --> 00:01:32,393 METROS IN THE TRANSITIVE CARE 18 00:01:32,393 --> 00:01:37,531 PORTFOLIO AND ALSO FOR THE NCI 19 00:01:37,531 --> 00:01:39,203 LEVEL INTERVENTION TRAINING. 20 00:01:39,203 --> 00:01:44,575 SHE IS GOING TO TALK TO US ON 21 00:01:44,575 --> 00:02:00,146 CARE CONDITIONS AND THANK YOU 22 00:02:00,146 --> 00:02:02,481 AND WELCOME, THE STAGE IS 23 00:02:02,481 --> 00:02:02,782 YOURS. 24 00:02:02,782 --> 00:02:13,325 >> GREAT, THANK YOU SO MUCH. 25 00:02:29,141 --> 00:02:30,309 >> THANK YOU SO MUCH FOR 26 00:02:30,309 --> 00:02:32,278 HAVING ME HERE TODAY. 27 00:02:32,278 --> 00:02:34,380 'EM REALLY EXCITED TO SHARE MY 28 00:02:34,380 --> 00:02:36,515 RESEARCH ON CARE COORDINATION 29 00:02:36,515 --> 00:02:41,353 AND TEAM EFFECTIVENESS FOR 30 00:02:41,353 --> 00:02:41,787 PATIENTS WITH 31 00:02:41,787 --> 00:02:42,421 MULTIMORBIDITIES. 32 00:02:42,421 --> 00:02:44,123 SO FOR THE BEGINNING I WOULD 33 00:02:44,123 --> 00:02:45,958 JUST LIKE TO ACKNOWLEDGE THAT 34 00:02:45,958 --> 00:02:51,163 THIS WAS SUPPORTED BY NIHMD 35 00:02:51,163 --> 00:02:54,099 VIA THE WILLIAM G COLEMAN 36 00:02:54,099 --> 00:02:57,303 MINORITY HEALTH AND HEALTH 37 00:02:57,303 --> 00:02:58,437 DISPARITIES RESEARCH 38 00:02:58,437 --> 00:03:00,406 INNOVATION AWARD AND LIKE TO 39 00:03:00,406 --> 00:03:02,608 SAY THE CONTENT IS SOLELY THE 40 00:03:02,608 --> 00:03:04,343 RESPONSIBILITY OF ME AND MY 41 00:03:04,343 --> 00:03:05,544 COWORKERS AND DON'T 42 00:03:05,544 --> 00:03:07,179 NECESSARILY REPRESENT THE WORK 43 00:03:07,179 --> 00:03:08,080 OF THE NIH. 44 00:03:08,080 --> 00:03:11,750 SO NOW LET'S GO AHEAD AND JUMP 45 00:03:11,750 --> 00:03:13,986 INTO THE RESEARCH. 46 00:03:13,986 --> 00:03:18,057 THIS IS THE CHRONIC HEALTH 47 00:03:18,057 --> 00:03:21,460 BURDEN WITH IMPACT TO 48 00:03:21,460 --> 00:03:22,361 MORTALITY. 49 00:03:22,361 --> 00:03:24,430 CANCER IS THE SECOND MOST 50 00:03:24,430 --> 00:03:25,197 PREVALENT CHRONIC CONDITION IN 51 00:03:25,197 --> 00:03:26,198 THE UNITED STATES AND ONE OUT 52 00:03:26,198 --> 00:03:27,600 OF THREE PEOPLE WILL HAVE 53 00:03:27,600 --> 00:03:29,235 CANCER IN THEIR LIFETIME. 54 00:03:29,235 --> 00:03:31,604 IT IS ALSO THE SECOND LEADING 55 00:03:31,604 --> 00:03:33,539 CAUSE OF MORTALITY IN THE U.S. 56 00:03:33,539 --> 00:03:36,809 AND NEARLY 60 PERCENT OF THOSE 57 00:03:36,809 --> 00:03:40,813 DIAGNOSED WITH CANCER WILL 58 00:03:40,813 --> 00:03:41,714 HAVE MULTIPLE 'CHRONIC MORE 59 00:03:41,714 --> 00:03:44,817 BIT TEASE AND THE MOST COMMON 60 00:03:44,817 --> 00:03:47,653 OF THESE INCLUDE 61 00:03:47,653 --> 00:03:48,254 CARDIOVASCULAR DISEASE, 62 00:03:48,254 --> 00:03:49,188 DIABETES, DEPRESSION AND 63 00:03:49,188 --> 00:03:51,123 ARTHRITIS. 64 00:03:51,123 --> 00:03:52,057 SO THE PREVALENCE OF 65 00:03:52,057 --> 00:03:56,161 MULTIMORBIDITY IS ALSO RISING 66 00:03:56,161 --> 00:03:59,365 AMONG CANCER PATIENTS AND 67 00:03:59,365 --> 00:04:00,165 DISPROPORTIONATELY IMPACTS 68 00:04:00,165 --> 00:04:03,502 THOSE LIVING WITH HIGH LEVELS 69 00:04:03,502 --> 00:04:06,772 OF DEPRIVATION OR 70 00:04:06,772 --> 00:04:07,206 COMORBIDITIES. 71 00:04:07,206 --> 00:04:08,874 THE STUDY REPORTED THAT THE 72 00:04:08,874 --> 00:04:12,244 DIAGNOSIS OCCURS AMONG BLACK 73 00:04:12,244 --> 00:04:13,646 AND YOUNGER CANCER SURVIVORS 74 00:04:13,646 --> 00:04:18,484 AND RATES OF MORBIDITY ARE 75 00:04:18,484 --> 00:04:21,253 ASSOCIATED WITH POOR HEALTH. 76 00:04:21,253 --> 00:04:25,457 THE CANCER DIAGNOSIS AND 77 00:04:25,457 --> 00:04:28,060 MULTIMORBIDY CAN HAVE IMPACT 78 00:04:28,060 --> 00:04:29,662 ON TREATMENT DECISIONS AND 79 00:04:29,662 --> 00:04:31,430 OUTCOMES ON THE CHRONIC 80 00:04:31,430 --> 00:04:34,033 CONDITION MANAGEMENT. 81 00:04:34,033 --> 00:04:36,702 IN TERMS OF CANCER, CANCERS 82 00:04:36,702 --> 00:04:39,071 ARE REALLY COMPLEX DISEASE AND 83 00:04:39,071 --> 00:04:41,273 REQUIRE DIFFERENT CARE TEAMS 84 00:04:41,273 --> 00:04:41,674 TO DIAGNOSE. 85 00:04:41,674 --> 00:04:43,909 THE RESPONSIBILITY OF THE 86 00:04:43,909 --> 00:04:45,077 DIFFERENT PROVIDERS SHIFTS 87 00:04:45,077 --> 00:04:47,246 ACROSS THIS PATHWAY FROM 88 00:04:47,246 --> 00:04:48,614 SYMPTOM DETECTION TO DIAGNOSIS 89 00:04:48,614 --> 00:04:49,315 TREATMENT. 90 00:04:49,315 --> 00:04:51,817 THE DIFFERENT PROVIDERS HAVE 91 00:04:51,817 --> 00:04:53,686 TO COORDINATE THEIR ACTIONS 92 00:04:53,686 --> 00:04:56,755 ACROSS CARE CONTINUUM TO 93 00:04:56,755 --> 00:04:58,023 ENSURE PATIENTS RECEIVE TIMELY 94 00:04:58,023 --> 00:04:58,390 CARE. 95 00:04:58,390 --> 00:04:59,224 THE PATIENTS WITH CHRONIC 96 00:04:59,224 --> 00:05:01,593 CONDITIONS AT THE TIME OF 97 00:05:01,593 --> 00:05:04,563 THEIR DIAGNOSIS ADD A LAYER OF 98 00:05:04,563 --> 00:05:05,364 COMPLEXITY. 99 00:05:05,364 --> 00:05:06,665 SO PATIENTS WITH DIABETES 100 00:05:06,665 --> 00:05:10,102 DURING THEIR DIAGNOSIS MIGHT 101 00:05:10,102 --> 00:05:11,337 HAVE AN ENDOCRINOLOGIST HELP 102 00:05:11,337 --> 00:05:17,543 MANAGE THEIR CONDITION AND 103 00:05:17,543 --> 00:05:20,379 DIETICIAN FOR DIETARY NEEDS. 104 00:05:20,379 --> 00:05:22,181 THEY COORDINATE ACROSS 105 00:05:22,181 --> 00:05:23,983 DIFFERENT MEDICAL SPECIALTIES 106 00:05:23,983 --> 00:05:28,420 TO ENSURE THAT THE TREATMENTS 107 00:05:28,420 --> 00:05:30,255 DON'T ADVERSELY IMPACT THE 108 00:05:30,255 --> 00:05:35,260 DISEASE MANAGEMENT AND HAVE TO 109 00:05:35,260 --> 00:05:39,932 WORK CLOSELY TO MANAGE COMPLEX 110 00:05:39,932 --> 00:05:40,466 MEDICATION REGIMENS. 111 00:05:40,466 --> 00:05:41,667 UNFORTUNATELY THIS ISN'T 112 00:05:41,667 --> 00:05:43,769 ALWAYS THE CASE SO PATIENTS 113 00:05:43,769 --> 00:05:47,172 ARE MORE LIKELY TO HAVE LATER 114 00:05:47,172 --> 00:05:49,875 STAGE DIAGNOSIS, FACE 115 00:05:49,875 --> 00:05:51,310 TREATMENT DELAYS OR POOR 116 00:05:51,310 --> 00:05:52,578 HEALTH OUTCOMES. 117 00:05:52,578 --> 00:05:56,782 THE TREATMENT OR GUIDELINE 118 00:05:56,782 --> 00:05:58,384 CONCORDANT CARE AND MANAGEMENT 119 00:05:58,384 --> 00:05:59,885 OF CHRONIC CONDITIONS. 120 00:05:59,885 --> 00:06:01,153 SO CARE COORDINATION OFFERS 121 00:06:01,153 --> 00:06:04,123 ONE WAY TO MITIGATE THE HEALTH 122 00:06:04,123 --> 00:06:07,092 DISPARITIES AND POOR HEALTH 123 00:06:07,092 --> 00:06:08,327 OUTCOMES ASSOCIATED WITH 124 00:06:08,327 --> 00:06:09,028 COMORBIDITY WITH CANCER. 125 00:06:09,028 --> 00:06:11,530 TO TAKE THE BURDEN OF CARE 126 00:06:11,530 --> 00:06:12,664 COORDINATION, IT IS IMPORTANT 127 00:06:12,664 --> 00:06:17,936 FOR PROVIDERS TO WORK AS A 128 00:06:17,936 --> 00:06:18,971 COLLABORATIVE 129 00:06:18,971 --> 00:06:20,806 MULTIDISCIPLINARY TEAM OR 130 00:06:20,806 --> 00:06:24,810 TEAMS OR MULTICARE TEAMS AND 131 00:06:24,810 --> 00:06:27,646 VARIOUS CLINICAL DISCIPLINES. 132 00:06:27,646 --> 00:06:29,348 THE STRATEGIES REALLY REMAIN 133 00:06:29,348 --> 00:06:29,681 UNKNOWN. 134 00:06:29,681 --> 00:06:32,718 FOR EXAMPLE, ONCE A PATIENT IS 135 00:06:32,718 --> 00:06:34,353 DIAGNOSED WITH CANCER, WHO IS 136 00:06:34,353 --> 00:06:35,187 MANAGING THE CHRONIC 137 00:06:35,187 --> 00:06:36,522 CONDITION? 138 00:06:36,522 --> 00:06:40,459 IS IT THE PRIMARY CARE TEAM OR 139 00:06:40,459 --> 00:06:41,493 MEDICAL SPECIALIST OR 140 00:06:41,493 --> 00:06:43,328 ENDOCRINOLOGIST? 141 00:06:43,328 --> 00:06:47,366 OR IS THE ENCOLLING TEAM 142 00:06:47,366 --> 00:06:48,600 MANAGING BY DEFAULT? 143 00:06:48,600 --> 00:06:51,003 THE DIFFERENT DISCIPLINE 144 00:06:51,003 --> 00:06:52,604 DIVERSITY AND MULTITEAM SYSTEM 145 00:06:52,604 --> 00:06:55,374 SIZE CAN CONTRIBUTE TO THE 146 00:06:55,374 --> 00:06:57,476 MULTITEAM SYSTEM COMPLEXITY. 147 00:06:57,476 --> 00:06:59,178 THE TEAM SIZE INCREASES OR 148 00:06:59,178 --> 00:07:00,312 THERE ARE DIFFERENT 149 00:07:00,312 --> 00:07:01,980 DISCIPLINES INVOLVED IN THE 150 00:07:01,980 --> 00:07:04,416 TEAM, THE COMPLEXITY TENDS TO 151 00:07:04,416 --> 00:07:06,251 INCREASE IN COMPARES TON SO 152 00:07:06,251 --> 00:07:08,554 TEAMS LOCATED WITH FEWER 153 00:07:08,554 --> 00:07:09,822 DISCIPLINES AND MEMBERS. 154 00:07:09,822 --> 00:07:11,156 WE DON'T REALLY KNOW HOW 155 00:07:11,156 --> 00:07:13,725 DIFFERENT ASPECTS OF THE 156 00:07:13,725 --> 00:07:15,694 MULTITEAM STRUCTURE SIZE AND 157 00:07:15,694 --> 00:07:17,863 COMPLEXITY IMPACT THE TEAM 158 00:07:17,863 --> 00:07:18,497 WORK PROCESS. 159 00:07:18,497 --> 00:07:20,966 SO THE AIMS OF THIS STUDY WERE 160 00:07:20,966 --> 00:07:23,268 TO ADDRESS THIS GAP AND 161 00:07:23,268 --> 00:07:26,171 EXAMINE HOW STRUCTURES IN THE 162 00:07:26,171 --> 00:07:29,174 MULTITEAM SYSTEM THAT IS TEAM 163 00:07:29,174 --> 00:07:33,612 COMPLEXY AND HOW THEY IMPACT 164 00:07:33,612 --> 00:07:34,780 CARE COORDINATION CHALLENGES 165 00:07:34,780 --> 00:07:36,515 AND EXPERIENCED BY CANCER 166 00:07:36,515 --> 00:07:38,083 PATIENTS IN THE 12 MONTHS 167 00:07:38,083 --> 00:07:39,618 FOLLOWING THEIR CANCER 168 00:07:39,618 --> 00:07:40,519 DIAGNOSIS. 169 00:07:40,519 --> 00:07:42,488 THIS WORK WAS GUIDED BY A 170 00:07:42,488 --> 00:07:44,556 FRAMEWORK I DEVELOPED WHILE 171 00:07:44,556 --> 00:07:46,792 WORKING AS A POST DOC AT THE 172 00:07:46,792 --> 00:07:48,160 NATIONAL CANCER INSTITUTE THAT 173 00:07:48,160 --> 00:07:49,194 DIFFERENTIATED THE TEAM WORK 174 00:07:49,194 --> 00:07:51,930 PROCESSES FROM SOME OF THE 175 00:07:51,930 --> 00:07:54,133 TASK WORK ASPECTS OF CANCER 176 00:07:54,133 --> 00:07:56,768 CARE DELIVERY AND OUTLINED 177 00:07:56,768 --> 00:08:00,772 SEVERAL DIFFERENT INPUTS LIKE 178 00:08:00,772 --> 00:08:03,008 THE TEAM GEOGRAPHIC DISPERSION 179 00:08:03,008 --> 00:08:05,644 OF THE TEAM AND HOW IT CAN 180 00:08:05,644 --> 00:08:07,346 IMPACT THE TEAM TOGETHER OR 181 00:08:07,346 --> 00:08:07,746 PROCESSES. 182 00:08:07,746 --> 00:08:11,016 TO ANSWER THESE QUESTIONS, WE 183 00:08:11,016 --> 00:08:14,853 CONDUCTED A METHOD STUDY USING 184 00:08:14,853 --> 00:08:16,054 EXPLANATORY SEQUENTIAL DESIGN. 185 00:08:16,054 --> 00:08:19,725 SO THIS TOOK THE PHASES WHERE 186 00:08:19,725 --> 00:08:21,126 WE FIRST ADMINISTERED THE 187 00:08:21,126 --> 00:08:22,928 QUESTIONS AND USING A PARALLEL 188 00:08:22,928 --> 00:08:25,030 QUESTION THAT WERE MATCHED TO 189 00:08:25,030 --> 00:08:26,198 THE QUANTITATIVE DATA AND 190 00:08:26,198 --> 00:08:29,535 AFTER WE COLLECTED AND CODED 191 00:08:29,535 --> 00:08:32,771 THE DATA WE MERGED THE 192 00:08:32,771 --> 00:08:34,173 QUANTITATIVE AND QUALITATIVE 193 00:08:34,173 --> 00:08:35,307 FINDINGS BY BRINGING THEM 194 00:08:35,307 --> 00:08:37,543 TOGETHER IN OUR ANALYSIS. 195 00:08:37,543 --> 00:08:39,144 OUR POPULATION INCLUDED CANCER 196 00:08:39,144 --> 00:08:40,445 SURVIVORS WITH AT LEAST ONE 197 00:08:40,445 --> 00:08:42,147 CHRONIC CONDITION AT THE TIME 198 00:08:42,147 --> 00:08:44,249 OF THEIR DIAGNOSIS AND ALL 199 00:08:44,249 --> 00:08:46,852 STUDY PROTOCOLS WERE APPROVED 200 00:08:46,852 --> 00:08:50,756 UNDER IRB EXEMPTION AT NIH. 201 00:08:50,756 --> 00:08:53,025 TO RECRUIT PARTICIPANTS WHO 202 00:08:53,025 --> 00:08:55,294 USE TWO ONLINE CROWD SOURCING 203 00:08:55,294 --> 00:08:57,963 BETWEEN APRIL AND 204 00:08:57,963 --> 00:09:00,465 NOVEMBER 2022 TO FACILITATE 205 00:09:00,465 --> 00:09:01,500 PARTICIPANT RECRUITMENT. 206 00:09:01,500 --> 00:09:04,703 SO THE TWO PLATFORMS WERE USED 207 00:09:04,703 --> 00:09:06,972 AND IN LINE WITH EACH OF THE 208 00:09:06,972 --> 00:09:11,043 SURVEY PLATFORMS AND 209 00:09:11,043 --> 00:09:11,743 INTERVIEWEES WERE COMPENSATED 210 00:09:11,743 --> 00:09:12,010 $50. 211 00:09:12,010 --> 00:09:13,445 AND IF YOU ARE WONDERING WHY 212 00:09:13,445 --> 00:09:15,047 WE USED TWO SURVEY PLATFORMS, 213 00:09:15,047 --> 00:09:17,749 WE WILL TALK A LITTLE BIT 214 00:09:17,749 --> 00:09:19,751 ABOUT THIS AT THE END WITH 215 00:09:19,751 --> 00:09:22,421 LESSONS LEARNED BUT ABOUT FOUR 216 00:09:22,421 --> 00:09:24,256 MONTHS OF RECRUITMENT VIA 217 00:09:24,256 --> 00:09:27,226 PROLIFIC, WE ONLY RECRUITED 218 00:09:27,226 --> 00:09:28,961 ABOUT 120 PARTICIPANTS AND 219 00:09:28,961 --> 00:09:30,729 NEEDED A LARGER SEAM FOR 220 00:09:30,729 --> 00:09:33,332 ANALYSIS SO SWITCHED OVER TO 221 00:09:33,332 --> 00:09:35,434 CROWD RESEARCH AND USED THEIR 222 00:09:35,434 --> 00:09:37,402 MANAGE RESEARCH OPTION. 223 00:09:37,402 --> 00:09:40,372 OUR PRIMARY PREDICTOR FOR THIS 224 00:09:40,372 --> 00:09:44,243 STUDY WAS TEAM COMPLEXITY WITH 225 00:09:44,243 --> 00:09:46,745 CLASSIFICATIONS OF MULTITEAM 226 00:09:46,745 --> 00:09:49,581 SYSTEMS TO CALCULATE THE 227 00:09:49,581 --> 00:09:49,982 CONDITIONS. 228 00:09:49,982 --> 00:09:52,718 SO HERE WE HAVE LOWER 229 00:09:52,718 --> 00:09:54,987 COMPLEXITY WITH ONE TO THREE 230 00:09:54,987 --> 00:09:56,154 PROVIDERS, MODERATE COMPLEXITY 231 00:09:56,154 --> 00:09:58,123 WITH FOUR PROVIDERS IN THE 232 00:09:58,123 --> 00:10:00,058 SAME HEALTH SYSTEM AND THEN 233 00:10:00,058 --> 00:10:01,560 HIGHER COMPLEXITY WITH MORE 234 00:10:01,560 --> 00:10:02,861 THAN FOUR DIFFERENT PROVIDERS 235 00:10:02,861 --> 00:10:05,264 FROM DIFFERENT HEALTH SYSTEMS. 236 00:10:05,264 --> 00:10:07,165 OUR PRIMARY OUTCOME WAS 237 00:10:07,165 --> 00:10:07,966 PERCEIVED TEAM EFFECTIVENESS. 238 00:10:07,966 --> 00:10:09,668 WE REALLY WANTED TO CAPTURE 239 00:10:09,668 --> 00:10:14,006 TEAM PROCESSES OF THE 240 00:10:14,006 --> 00:10:16,074 PROVIDERS AFTER AND AFTER 241 00:10:16,074 --> 00:10:21,713 REVIEWING THE LITERATURE, WE 242 00:10:21,713 --> 00:10:23,248 THOSE KILPATRICK'S OUTCOMES OF 243 00:10:23,248 --> 00:10:24,049 CARE. 244 00:10:24,049 --> 00:10:26,051 THE PERCEIVED TEAM 245 00:10:26,051 --> 00:10:26,685 EFFECTIVENESS CAPTURED 8 246 00:10:26,685 --> 00:10:27,352 DIFFERENT PROCESSES AND THE 247 00:10:27,352 --> 00:10:29,855 REASON WE WANTED TO MEASURE 248 00:10:29,855 --> 00:10:31,590 THIS IS BECAUSE CARE 249 00:10:31,590 --> 00:10:32,958 COORDINATION AND TEAM WORK 250 00:10:32,958 --> 00:10:36,261 ISN'T JUST ONE ASPECT. 251 00:10:36,261 --> 00:10:37,629 THERE'S LOTS OF DIFFERENT 252 00:10:37,629 --> 00:10:39,831 DIMENSIONS THAT GO INTO 253 00:10:39,831 --> 00:10:40,332 COORDINATING CARE. 254 00:10:40,332 --> 00:10:43,969 SO THAT IS WHY WE CHOSE THIS 255 00:10:43,969 --> 00:10:44,970 SPECIFIC MEASURE. 256 00:10:44,970 --> 00:10:51,176 ALL OF THESE WERE RATED ON ONE 257 00:10:51,176 --> 00:10:53,612 TO SEVEN WITH AGREE AND 258 00:10:53,612 --> 00:10:56,114 STRONGLY AGREE AND OUTCOMES OF 259 00:10:56,114 --> 00:10:58,317 CARE EVAL THINGS LIKE 260 00:10:58,317 --> 00:11:00,485 TIMELINESS OF CARE AND WHETHER 261 00:11:00,485 --> 00:11:02,754 PATIENTS' QUESTIONS WERE BEING 262 00:11:02,754 --> 00:11:03,355 ANSWERED. 263 00:11:03,355 --> 00:11:06,591 THE STATISTICAL ANALYSIS 264 00:11:06,591 --> 00:11:07,292 INCLUDED DESCRIPTIVE 265 00:11:07,292 --> 00:11:09,361 STOPPIVITY TICKS OF THE 266 00:11:09,361 --> 00:11:12,464 PATIENT, CHARACTERISTICS, TEAM 267 00:11:12,464 --> 00:11:13,832 COMPOSITION, COMPLEXITY AND 268 00:11:13,832 --> 00:11:15,867 CARE CHALLENGES AND THEN TESTS 269 00:11:15,867 --> 00:11:18,370 TO EXAMINE HOW TEAM PROCESSES 270 00:11:18,370 --> 00:11:20,439 DIFFERED FOR HIGHER LOW 271 00:11:20,439 --> 00:11:22,741 COMPLEXITY TEAMS. 272 00:11:22,741 --> 00:11:24,276 SO FOR THE QUALITATIVE 273 00:11:24,276 --> 00:11:28,680 METHODS, WE USED ANALYTIC 274 00:11:28,680 --> 00:11:30,749 METHODS WITH CONSTANT 275 00:11:30,749 --> 00:11:33,819 COMPARATIVE METHOD AND AUDIO 276 00:11:33,819 --> 00:11:35,987 RECORDED AND TRANSCRIBED 277 00:11:35,987 --> 00:11:41,593 UPLOADED BY Dr. MICHELLE 278 00:11:41,593 --> 00:11:45,464 JU'S DEVELOPED CODE AND THIS 279 00:11:45,464 --> 00:11:48,233 IS AN ITERATIVE APPROACH AND 280 00:11:48,233 --> 00:11:49,768 THEN THE PRIMARY THEMES THAT I 281 00:11:49,768 --> 00:11:52,270 CAN TALK ABOUT IF PEOPLE WANT 282 00:11:52,270 --> 00:11:54,940 ADDITIONAL CONTEXT RELATED TO 283 00:11:54,940 --> 00:11:55,874 THE DIFFERENT CRITERIA HERE. 284 00:11:55,874 --> 00:11:59,778 SO IN TERMS OF OUR RESULTS ON 285 00:11:59,778 --> 00:12:02,581 A TOTAL OF 441 CANCER 286 00:12:02,581 --> 00:12:06,184 SURVIVORS COMPLETED THE 287 00:12:06,184 --> 00:12:09,454 SURVEY, SURVEY RESPONDENTS 288 00:12:09,454 --> 00:12:10,956 WERE PREDOMINANTLY FEMALE, 289 00:12:10,956 --> 00:12:13,458 NONE HISPANIC WHITE AND 290 00:12:13,458 --> 00:12:18,497 13 PERCENT SELF IDENTIFIED AS 291 00:12:18,497 --> 00:12:29,074 ASEXUAL OR GENDER MINORITY AND 292 00:12:30,609 --> 00:12:32,644 INDIVIDUALS THAT IDENTIFIED 293 00:12:32,644 --> 00:12:34,946 WERE CLASSIFIED AS SEXUAL 294 00:12:34,946 --> 00:12:35,514 ORIGIN. 295 00:12:35,514 --> 00:12:37,015 16PERCENT OF OUR POPULATION 296 00:12:37,015 --> 00:12:42,120 WERE FROM RURAL AREAS AND MOST 297 00:12:42,120 --> 00:12:43,722 WERE PRIVATELY INSURED, 298 00:12:43,722 --> 00:12:44,623 28 PERCENT FINDING IT 299 00:12:44,623 --> 00:12:46,191 DIFFICULT TO GET BY. 300 00:12:46,191 --> 00:12:52,764 THE MOST PREVALENT CANCER WAS 301 00:12:52,764 --> 00:12:55,333 BREAST, SKIN, GYNECOLOGICAL OR 302 00:12:55,333 --> 00:12:59,237 ENDOCRINE THYROID. 303 00:12:59,237 --> 00:13:02,307 MOST WERE DIAGNOSED AT AN 304 00:13:02,307 --> 00:13:03,341 EARLY STAGE, STAGES 1 THROUGH 305 00:13:03,341 --> 00:13:11,316 3 AND THE MOST COMMON 306 00:13:11,316 --> 00:13:12,784 COMORBIDITIES INCLUDED 307 00:13:12,784 --> 00:13:13,852 CONFERENCE, HYPERTENSION, 308 00:13:13,852 --> 00:13:17,589 ARTHRITIS, OVER 67 PERCENT OF 309 00:13:17,589 --> 00:13:20,358 OUR SAMPLE HAD 310 00:13:20,358 --> 00:13:21,126 MULTICOMORBIDITIES AND OTHER 311 00:13:21,126 --> 00:13:21,460 CANCERS. 312 00:13:21,460 --> 00:13:23,895 ONE-THIRD OF OUR SAMPLE WAS 313 00:13:23,895 --> 00:13:25,163 DIAGNOSED LESS THAN TWO YEARS 314 00:13:25,163 --> 00:13:26,865 AGO AND MOST UNDERWENT 315 00:13:26,865 --> 00:13:28,700 TREATMENT LESS THAN TWO YEARS 316 00:13:28,700 --> 00:13:30,902 AGO OR OVER FIVE YEARS AGO. 317 00:13:30,902 --> 00:13:32,838 ON AVERAGE, PEOPLE RECEIVED 318 00:13:32,838 --> 00:13:34,473 BETWEEN TWO TO THREE DIFFERENT 319 00:13:34,473 --> 00:13:36,975 TREATMENTS AND SURGERY WAS THE 320 00:13:36,975 --> 00:13:39,277 MOST PREVALENT FOLLOWED BY 321 00:13:39,277 --> 00:13:41,580 THEME THERAPY AND RADIATION. 322 00:13:41,580 --> 00:13:43,515 AND IN TERMS OF TEAM 323 00:13:43,515 --> 00:13:45,450 COMPOSITION, THE AVERAGE 324 00:13:45,450 --> 00:13:47,652 NUMBER OF PROVIDERS SEEN WAS 325 00:13:47,652 --> 00:13:49,754 4.5 SO PEOPLE TENDED TO SEE 326 00:13:49,754 --> 00:13:52,390 BETWEEN FOUR AND FIVE 327 00:13:52,390 --> 00:13:53,892 DIFFERENT CLINICIANS. 328 00:13:53,892 --> 00:13:56,061 ONCOLOGY PROVIDERS, PEOPLE SAW 329 00:13:56,061 --> 00:13:58,797 BETWEEN ONE OR TWO DIFFERENT 330 00:13:58,797 --> 00:14:04,736 ONCOLOGY PROVIDERS AND IN 331 00:14:04,736 --> 00:14:09,441 TERMS OF UNIQUE COMORBIDITIES, 332 00:14:09,441 --> 00:14:11,343 ONCOLOGY PROVIDERS AND OTHER 333 00:14:11,343 --> 00:14:12,744 MEDICAL SPECIALISTS A PATIENT 334 00:14:12,744 --> 00:14:15,580 MIGHT SEE, PATIENTS TENDED TO 335 00:14:15,580 --> 00:14:24,756 SEE BETWEEN FOUR -- THREE AND 336 00:14:24,756 --> 00:14:25,824 FOUR HIGH-TEAM COMPLEXITIES. 337 00:14:25,824 --> 00:14:33,064 IN TERMS OF TEAM COMPLEXITY, 338 00:14:33,064 --> 00:14:34,666 MOST PARTICIPANTS HAD MODERATE 339 00:14:34,666 --> 00:14:36,935 TO LOW COMPLEXITY SO 340 00:14:36,935 --> 00:14:42,007 49 PERCENT FOLLOWED BY LOW 341 00:14:42,007 --> 00:14:45,076 TEAM COMPLEXITY. 342 00:14:45,076 --> 00:14:47,245 THE ANALYSIS ILLUSTRATES THE 343 00:14:47,245 --> 00:14:49,080 HIGH TEAM COMPLEXITY WITH 344 00:14:49,080 --> 00:14:51,249 LOWER SAMPLES AND THE ANALYSIS 345 00:14:51,249 --> 00:14:53,785 WASN'T POWERED TO DO THE 346 00:14:53,785 --> 00:14:54,920 ADDITIONAL RESEARCH QUESTIONS 347 00:14:54,920 --> 00:14:58,189 RELATED TO THOSE DIFFERENT 348 00:14:58,189 --> 00:14:58,890 SOCIODEMOGRAPHIC VARIABLES. 349 00:14:58,890 --> 00:15:03,161 THE RESPONSE ITEMS HERE WERE 350 00:15:03,161 --> 00:15:03,495 RECODED. 351 00:15:03,495 --> 00:15:06,765 SO ITEMS 1 THROUGH 5 WERE 352 00:15:06,765 --> 00:15:08,700 RECATEGORIZED AS LOW 353 00:15:08,700 --> 00:15:10,869 FUNCTIONING TEAMS, RESPONSES 6 354 00:15:10,869 --> 00:15:13,738 AND 7 WERE CATEGORIZED AS HIGH 355 00:15:13,738 --> 00:15:15,807 FUNCTIONING TEAMS AND OVERALL 356 00:15:15,807 --> 00:15:17,976 81 PERCENT OF PARTICIPANTS 357 00:15:17,976 --> 00:15:19,678 RELATED THEIR PERCEIVED 358 00:15:19,678 --> 00:15:20,745 TESTIMONY EFFECTIVENESS SCORE 359 00:15:20,745 --> 00:15:21,980 WAS 6. 360 00:15:21,980 --> 00:15:23,882 HERE I HAVE HIGHLIGHTED A FEW 361 00:15:23,882 --> 00:15:27,552 OF THE LOWEST RATED TEAM 362 00:15:27,552 --> 00:15:29,054 PROCESSES INCLUDING 363 00:15:29,054 --> 00:15:29,754 COMMUNICATION, PROBLEM-SOLVING 364 00:15:29,754 --> 00:15:31,489 ABILITIES OF THE TEAM AND 365 00:15:31,489 --> 00:15:35,894 PATIENT FAMILY FOCUS OF THE 366 00:15:35,894 --> 00:15:36,695 TEAM. 367 00:15:36,695 --> 00:15:39,798 THERE WAS AN INVERSE 368 00:15:39,798 --> 00:15:41,633 RELATIONSHIP FOUND BETWEEN PTE 369 00:15:41,633 --> 00:15:44,502 OVERALL AND TEAM COMPLEXITY SO 370 00:15:44,502 --> 00:15:49,207 AS TEAM COMPLEXITY INCREASED, 371 00:15:49,207 --> 00:15:51,076 THE PERCEIVED EFFECTIVENESS 372 00:15:51,076 --> 00:15:52,310 OVERALL DECREASED. 373 00:15:52,310 --> 00:15:54,512 HIGH TEAM COMPLEXITY WAS ALSO 374 00:15:54,512 --> 00:15:58,850 RELATED TO DECREASED PROBLEM 375 00:15:58,850 --> 00:16:00,251 SOLVING AND DECREASED PATIENT 376 00:16:00,251 --> 00:16:01,853 FAMILY FOCUS HOWEVER THERE WAS 377 00:16:01,853 --> 00:16:03,822 NO ASSOCIATIONS FOUND BETWEEN 378 00:16:03,822 --> 00:16:05,490 THE COMPLEXITY OF THE TEAM AND 379 00:16:05,490 --> 00:16:06,925 OTHER TEAM PROCESSES. 380 00:16:06,925 --> 00:16:08,259 WHEN LOOKING AT THE DIFFERENT 381 00:16:08,259 --> 00:16:13,932 TEAM PROCESSES, WE FOCUSED ON 382 00:16:13,932 --> 00:16:15,767 THEMES THAT EMERGE FROM BOTH 383 00:16:15,767 --> 00:16:18,236 THE SURVEYS AND INTERVIEW 384 00:16:18,236 --> 00:16:20,772 RESPONDENS SO THIS INCLUDED 385 00:16:20,772 --> 00:16:23,508 THINGS LIKE COORDINATION, 386 00:16:23,508 --> 00:16:24,542 SHARED MENTAL MODELS, PATIENT 387 00:16:24,542 --> 00:16:26,277 FAMILY FOCUS AND I AM GOING TO 388 00:16:26,277 --> 00:16:29,147 DIVE INTO SOME OF THOSE NOW. 389 00:16:29,147 --> 00:16:31,983 SO COORDINATION WAS MOST 390 00:16:31,983 --> 00:16:33,284 POSITIVELY VIEWED TEAM PROCESS 391 00:16:33,284 --> 00:16:35,954 WITH 85 PERCENT OF 392 00:16:35,954 --> 00:16:37,889 PARTICIPANTS RATING IT AS HIGH 393 00:16:37,889 --> 00:16:40,525 AND 78 PERCENT RATING THEIR 394 00:16:40,525 --> 00:16:47,098 CARE AS BEING WELL ORGANIZED. 395 00:16:47,098 --> 00:16:48,733 THE CARE COORDINATION PLAN WAS 396 00:16:48,733 --> 00:16:51,002 REVIEWED AHEAD OF TIME AND IF 397 00:16:51,002 --> 00:16:55,340 THEY WERE ALIGNED WITH WHAT 398 00:16:55,340 --> 00:16:57,042 THE PROVIDERS TREATMENT CARE 399 00:16:57,042 --> 00:16:59,244 PLANS WERE. 400 00:16:59,244 --> 00:17:01,046 AND ALSO THE PATIENTS HAD THE 401 00:17:01,046 --> 00:17:04,516 SAME INSURANCE NETWORK AND 402 00:17:04,516 --> 00:17:08,219 FINALLY PARTICIPANTS HAVING A 403 00:17:08,219 --> 00:17:10,855 "QUARTERBACK Q ON THE TEAM 404 00:17:10,855 --> 00:17:12,357 MAKING SURE EVERYONE IS ON THE 405 00:17:12,357 --> 00:17:14,092 SAME PAGE AND HAS A SHARED 406 00:17:14,092 --> 00:17:15,293 UNDERSTANDING OF WHAT IS GOING 407 00:17:15,293 --> 00:17:16,528 ON. 408 00:17:16,528 --> 00:17:22,033 IN TERMS OF BARRIERS TO 409 00:17:22,033 --> 00:17:24,769 COORDINATION, THE PREDOMINANT 410 00:17:24,769 --> 00:17:25,603 THEMES INCLUDED HAVING 411 00:17:25,603 --> 00:17:28,573 SEQUENTIAL REFERRALS WITH NO 412 00:17:28,573 --> 00:17:30,375 INTEGRATION SO BOUNCED AROUND 413 00:17:30,375 --> 00:17:31,309 BETWEEN DIFFERENT PROVIDERS 414 00:17:31,309 --> 00:17:33,278 BUT NOT HAVING THAT INTEGRATED 415 00:17:33,278 --> 00:17:35,113 CARE PLAN GIVEN TO THEM. 416 00:17:35,113 --> 00:17:37,415 SOME PATIENTS REPORTED THEY 417 00:17:37,415 --> 00:17:39,384 DIDN'T HAVE A CARE PLAN. 418 00:17:39,384 --> 00:17:40,585 DURING THE INTERVIEWS, WE 419 00:17:40,585 --> 00:17:41,820 ASKED WHAT THEIR TREATMENT 420 00:17:41,820 --> 00:17:44,322 PLAN LOOKED LIKE AND SOME 421 00:17:44,322 --> 00:17:45,156 PEOPLE REPORTED THAT THEY 422 00:17:45,156 --> 00:17:47,592 DIDN'T KNOW HOW TO ANSWER THAT 423 00:17:47,592 --> 00:17:49,728 BECAUSE THEY DIDN'T HAVE A 424 00:17:49,728 --> 00:17:51,429 CLEAR TREATMENT PLAN, THEY 425 00:17:51,429 --> 00:17:52,931 WENT TO DIFFERENT APPOINTMENTS 426 00:17:52,931 --> 00:17:54,232 THEY WERE REFERRED TO AND 427 00:17:54,232 --> 00:17:58,069 DIDN'T HAVE A KIND OF 428 00:17:58,069 --> 00:18:00,138 INTEGRATION ACROSS THOSE 429 00:18:00,138 --> 00:18:03,174 DIFFERENT CARE PROVIDERS. 430 00:18:03,174 --> 00:18:04,042 THE LARGEST BARRIER WAS 431 00:18:04,042 --> 00:18:06,745 COORDINATION AND I PULLED THIS 432 00:18:06,745 --> 00:18:11,282 QUOTE FROM ONE OF THE 433 00:18:11,282 --> 00:18:13,585 RESPONDENTS WHO SAID ONCE YOU 434 00:18:13,585 --> 00:18:15,153 HAVE CANCER, YOU THOUGHT 435 00:18:15,153 --> 00:18:17,021 EVERYTHING WOULD STOP AND 436 00:18:17,021 --> 00:18:18,423 DOCTORS WOULD JUMP RIGHT ON IT 437 00:18:18,423 --> 00:18:20,191 AND THAT WASN'T THE CASE. 438 00:18:20,191 --> 00:18:23,128 THEY WERE GOING TO HAVE TO 439 00:18:23,128 --> 00:18:24,295 FIGHT FOR THEIR APPOINTMENTS 440 00:18:24,295 --> 00:18:26,698 TO FIND DOCTORS ON THEIR OWN 441 00:18:26,698 --> 00:18:27,932 AND ACTUALLY FIND DOCTORS THAT 442 00:18:27,932 --> 00:18:29,434 HAD THE SAME VISION FOR THEIR 443 00:18:29,434 --> 00:18:32,537 CARE THAT I DID. 444 00:18:32,537 --> 00:18:37,742 IN TERMS OF COMMUNICATION, 445 00:18:37,742 --> 00:18:39,277 69 PERCENT RATED COMMUNICATION 446 00:18:39,277 --> 00:18:41,880 HIGH AND INCLUDED THINGS LIKE 447 00:18:41,880 --> 00:18:43,715 SHARED ELECTRONIC HEALTH 448 00:18:43,715 --> 00:18:46,417 RECORDS AND CLOSED LOOP 449 00:18:46,417 --> 00:18:47,051 COMMUNICATION. 450 00:18:47,051 --> 00:18:48,486 IT WAS INTERESTING THAT 451 00:18:48,486 --> 00:18:50,822 SEVERAL PARTICIPANTS NOTED IN 452 00:18:50,822 --> 00:18:53,992 TERMS OF EHR THEY COULD SEE 453 00:18:53,992 --> 00:18:55,493 THE DIFFERENT SCANS OR IF 454 00:18:55,493 --> 00:18:57,228 THEIR DOCTORS WERE TALKING 455 00:18:57,228 --> 00:18:59,731 BACK AND FORTH, IT SERVED AS 456 00:18:59,731 --> 00:19:01,366 LIKE THIS DIGITAL TRACE OF 457 00:19:01,366 --> 00:19:02,734 COMMUNICATION ACROSS THE 458 00:19:02,734 --> 00:19:04,335 DIFFERENT PROVIDERS AND IN 459 00:19:04,335 --> 00:19:06,504 TERMS OF CLOSED LOOP 460 00:19:06,504 --> 00:19:07,772 COMMUNICATION PATIENTS FELT 461 00:19:07,772 --> 00:19:12,310 LIKE WHEN THEY WEPT TO THEIR 462 00:19:12,310 --> 00:19:15,180 PRIMARY CARE DOCTOR, THEY SAID 463 00:19:15,180 --> 00:19:19,417 I SAW YOUR ONCOLOGIST DID XYZ 464 00:19:19,417 --> 00:19:24,923 AND THIS COMMUNICATION WAS 465 00:19:24,923 --> 00:19:26,858 OCCURRING ACROSS DIFFERENT 466 00:19:26,858 --> 00:19:28,793 CARE AND BARRIERS IN TERMS OF 467 00:19:28,793 --> 00:19:32,096 THE PATIENT. 468 00:19:32,096 --> 00:19:35,200 IN TERMS OF THE PATIENT HAVING 469 00:19:35,200 --> 00:19:37,368 TO COMMUNICATE FOR THE TEAM, 470 00:19:37,368 --> 00:19:42,240 ASKING THEM TO SHARE 471 00:19:42,240 --> 00:19:43,274 INFORMATION, ASK QUESTIONS 472 00:19:43,274 --> 00:19:46,911 REPEATING STUFF OVER AND OVER 473 00:19:46,911 --> 00:19:49,514 AND SOME FELT THEY DIDN'T 474 00:19:49,514 --> 00:19:51,850 THINK THE TEAM EVER TALKED. 475 00:19:51,850 --> 00:19:53,351 FOR SHARED MENTAL MODERATE 476 00:19:53,351 --> 00:19:55,854 KELS, 78 PERCENT RATED THEIR 477 00:19:55,854 --> 00:19:57,021 SHARED DECISION MAKING OF THE 478 00:19:57,021 --> 00:19:59,390 TEAM HIGH AND ONLY 49 PERCENT 479 00:19:59,390 --> 00:20:00,158 RATED PROBLEM SOLVING 480 00:20:00,158 --> 00:20:03,895 ABILITIES OF THE TEAM AS HIGH. 481 00:20:03,895 --> 00:20:04,829 SOME FACILITATORS REPORTED 482 00:20:04,829 --> 00:20:06,531 THINGS AS HAVING THE SAME GOAL 483 00:20:06,531 --> 00:20:10,902 TO GET THE PATIENT HEALTHY, SO 484 00:20:10,902 --> 00:20:12,203 THE PROVIDERS UNDERSTANDING OF 485 00:20:12,203 --> 00:20:13,872 YES, WE ARE ALL WORKING 486 00:20:13,872 --> 00:20:15,273 TOGETHER ON THE SAME GOAL TO 487 00:20:15,273 --> 00:20:19,978 GET THE PATIENT HEALTHY AND 488 00:20:19,978 --> 00:20:22,881 KIND OF CHECKED THEIR HEGO AT 489 00:20:22,881 --> 00:20:24,816 THE DOOR TO WORK TOGETHER, 490 00:20:24,816 --> 00:20:28,686 COMING FROM DIFFERENT 491 00:20:28,686 --> 00:20:31,289 EXPERTISE AND DIFFERENT 492 00:20:31,289 --> 00:20:33,524 CONDITIONS AND SOME PATIENTS 493 00:20:33,524 --> 00:20:35,126 ON DIFFERENT TREATMENTS MIGHT 494 00:20:35,126 --> 00:20:37,328 NOT UNDERSTAND HOW THAT COULD 495 00:20:37,328 --> 00:20:40,265 IMPACT CANCER CARE AND VICE 496 00:20:40,265 --> 00:20:42,734 VERSE IS A AND REPORTED 497 00:20:42,734 --> 00:20:44,335 SOMETHING DOCTORS WORK 498 00:20:44,335 --> 00:20:45,970 TOGETHER ACROSS THOSE 499 00:20:45,970 --> 00:20:49,307 BOUNDARIES, PUTTING THEIR EGO 500 00:20:49,307 --> 00:20:52,877 ASIDE WAS HELPFUL AND FINALLY 501 00:20:52,877 --> 00:20:54,812 HAVING A MULTIDISCIPLINARY 502 00:20:54,812 --> 00:20:58,049 CLINICAL STRUCTURE AND SHARED 503 00:20:58,049 --> 00:20:58,716 MENTAL MODEL. 504 00:20:58,716 --> 00:21:00,585 WHEN YOU COME INTO THE CLINIC, 505 00:21:00,585 --> 00:21:02,987 YOU ARE DIAGNOSED WITH CANCER, 506 00:21:02,987 --> 00:21:04,722 THEY HAVE IT SET WHERE YOU SEE 507 00:21:04,722 --> 00:21:06,157 ALL YOUR DIFFERENT PROVIDERS 508 00:21:06,157 --> 00:21:07,825 THE SAME DAY. 509 00:21:07,825 --> 00:21:10,828 SO YOU MIGHT SEE YOUR SURGEON, 510 00:21:10,828 --> 00:21:12,463 RADIATION ONCOLOGIST ALL THE 511 00:21:12,463 --> 00:21:14,565 SAME DAY TO AVOID HAVING TO GO 512 00:21:14,565 --> 00:21:17,869 BACK AND FORTH FOR THOSE 513 00:21:17,869 --> 00:21:19,470 APPOINTMENTS AND FACILITATES 514 00:21:19,470 --> 00:21:21,773 SHARED TREATMENT PLANS ACROSS 515 00:21:21,773 --> 00:21:22,140 PROVIDERS. 516 00:21:22,140 --> 00:21:24,742 AND SOME OF THE BARRIERS, IT 517 00:21:24,742 --> 00:21:25,643 WAS REPORTED NONE OF THE 518 00:21:25,643 --> 00:21:30,014 DOCTORS WERE ON THE SAME PAGE 519 00:21:30,014 --> 00:21:32,383 AND CONFLICTING OPINIONS AND 520 00:21:32,383 --> 00:21:33,318 INFORMATION FROM DIFFERENT 521 00:21:33,318 --> 00:21:34,218 DISCIPLINES EVEN WHEN THEY 522 00:21:34,218 --> 00:21:39,691 HAVE A SHARED HEALTH SYSTEM OR 523 00:21:39,691 --> 00:21:40,024 EHR. 524 00:21:40,024 --> 00:21:42,760 PATIENT FAMILY FOCUS WAS THE 525 00:21:42,760 --> 00:21:44,729 MOST NEGATIVELY VIEWED TEAM 526 00:21:44,729 --> 00:21:45,096 PROCESS. 527 00:21:45,096 --> 00:21:49,500 ONLY 54 PERCENT OF 528 00:21:49,500 --> 00:21:50,635 PARTICIPANTS -- SORRY, ONLY 529 00:21:50,635 --> 00:21:52,003 46 PERCENT RATED PATIENT 530 00:21:52,003 --> 00:21:54,072 FAMILY FOCUS IS HIGH AND THIS 531 00:21:54,072 --> 00:21:56,407 IS SAYING THAT THEY DIDN'T 532 00:21:56,407 --> 00:21:58,643 REALLY FEEL LIKE THEIR CARE 533 00:21:58,643 --> 00:22:00,178 TEAM FELT THE PATIENTS HAD A 534 00:22:00,178 --> 00:22:01,779 ROLE TO PLAY, THEIR FAMILY 535 00:22:01,779 --> 00:22:03,147 WASN'T INVOLVED IN THE CARE 536 00:22:03,147 --> 00:22:04,415 DECISION AND THE CARE TEAM 537 00:22:04,415 --> 00:22:05,516 DIDN'T VIEW THE PATIENT AS A 538 00:22:05,516 --> 00:22:06,551 PART OF THE TEAM. 539 00:22:06,551 --> 00:22:09,120 SO KIND OF LIKE YOU ARE BEING 540 00:22:09,120 --> 00:22:11,522 TOLD WHAT TO DO BUT NOT BEING 541 00:22:11,522 --> 00:22:12,657 INVOLVED IN THE 542 00:22:12,657 --> 00:22:15,026 DECISION-MAKING PROCESS. 543 00:22:15,026 --> 00:22:16,828 SO FACILITATORS ARE CREATING 544 00:22:16,828 --> 00:22:19,797 MORE PATIENT FAMILY FOCUS IN 545 00:22:19,797 --> 00:22:22,300 THAT SHARED DECISION MODEL 546 00:22:22,300 --> 00:22:27,739 INCLUDING HAVING A TRUSTED 547 00:22:27,739 --> 00:22:28,673 PATIENT Dr. RELATIONSHIP, 548 00:22:28,673 --> 00:22:30,742 INCLUSION OF FAMILY AND 549 00:22:30,742 --> 00:22:34,645 ENGAGING IN SHARED 550 00:22:34,645 --> 00:22:35,480 DECISION-MAKING. 551 00:22:35,480 --> 00:22:36,948 BARRIERS, NOT HAVING CONCERNS, 552 00:22:36,948 --> 00:22:39,484 NEEDS OR PREFERENCES VALUED, 553 00:22:39,484 --> 00:22:41,652 ESPECIALLY AS IT RELATES TO 554 00:22:41,652 --> 00:22:43,855 FINANCES, EMPLOYMENT AND TIME. 555 00:22:43,855 --> 00:22:45,656 FOR EXAMPLE, IT CAN TAKE A 556 00:22:45,656 --> 00:22:47,392 WHILE TO GET CLEARED TO GO 557 00:22:47,392 --> 00:22:50,528 BACK TO WORK AND ONE 558 00:22:50,528 --> 00:22:51,963 INTERVIEWEE REPORTED THEY FELT 559 00:22:51,963 --> 00:22:58,002 THEY WERE READY TO RETURN BUT 560 00:22:58,002 --> 00:23:00,405 THEY WERE GETTING DEPRESSIONED 561 00:23:00,405 --> 00:23:03,141 WAITING AT HOME TO BE RETURNED 562 00:23:03,141 --> 00:23:06,411 TO THE WORKFORCE AND SOME OF 563 00:23:06,411 --> 00:23:09,781 THE HEALTH OR CARE NEEDS WHEN 564 00:23:09,781 --> 00:23:11,816 CARE COORDINATION MECHANISMS 565 00:23:11,816 --> 00:23:12,884 OR MODALITIES WERE ABSENT. 566 00:23:12,884 --> 00:23:17,021 I THINK THE TAKEAWAYS WITH 567 00:23:17,021 --> 00:23:17,522 COORDINATION AND 568 00:23:17,522 --> 00:23:20,725 DECISION-MAKING, ALL THE 569 00:23:20,725 --> 00:23:22,093 INTERVIEWEES REPORTED YES 570 00:23:22,093 --> 00:23:24,162 THINGS THAT HELPED CONTRIBUTE 571 00:23:24,162 --> 00:23:27,331 TO THAT POSITIVE PERSPECTIVE 572 00:23:27,331 --> 00:23:29,067 OF THEIR CARE COORDINATION BUT 573 00:23:29,067 --> 00:23:32,136 HAD INTERESTING THINGS TO TALK 574 00:23:32,136 --> 00:23:36,240 ABOUT THE NEGATIVE SIDES OR 575 00:23:36,240 --> 00:23:40,011 BARRIERS THEY FACED AND THE 576 00:23:40,011 --> 00:23:41,612 BENEFITS OF ADMINISTERING A 577 00:23:41,612 --> 00:23:42,780 SURVEY BECAUSE WE WOULDN'T 578 00:23:42,780 --> 00:23:44,882 HAVE GOT TEN THIS NUANCE. 579 00:23:44,882 --> 00:23:46,350 IN TERMS OF IMPLICATIONS AND 580 00:23:46,350 --> 00:23:49,120 NEXT STEPS, WE THINK THE STUDY 581 00:23:49,120 --> 00:23:50,855 IS REALLY INTERESTING BECAUSE 582 00:23:50,855 --> 00:23:53,925 IT GETS AT A YOUNGER 583 00:23:53,925 --> 00:23:56,327 POPULATION OF CANCER SURVIVORS 584 00:23:56,327 --> 00:24:01,899 THAN LARGE MEDICAL DATABASES 585 00:24:01,899 --> 00:24:07,138 LIKE SEER MEDICARE ALLOWS. 586 00:24:07,138 --> 00:24:11,042 MOST OF THE MEDICARE DATABASES 587 00:24:11,042 --> 00:24:14,112 ARE AGE 65 OR OLDER. 588 00:24:14,112 --> 00:24:15,246 COMPOSITION MATTERS, WHO IS 589 00:24:15,246 --> 00:24:18,549 INVOLVED IN YOUR CARE AND BEST 590 00:24:18,549 --> 00:24:19,517 COORDINATING IMPACTS OF 591 00:24:19,517 --> 00:24:21,319 DIFFERENT OUTCOMES OF CARE AND 592 00:24:21,319 --> 00:24:24,188 THEN I THINK IT REALLY 593 00:24:24,188 --> 00:24:25,756 HIGHLIGHTS THE CARE DIVERSITY 594 00:24:25,756 --> 00:24:27,325 IN THE PROCESS SO THE PROCESS 595 00:24:27,325 --> 00:24:28,826 NEEDED AT ONE POINT IN TIME 596 00:24:28,826 --> 00:24:30,795 MAY NOT BE THE SAME NEEDED AT 597 00:24:30,795 --> 00:24:34,932 A LATER POINT AND CAN BE BASED 598 00:24:34,932 --> 00:24:36,367 ON EMERGENT NEEDS OF THE 599 00:24:36,367 --> 00:24:36,734 PATIENT. 600 00:24:36,734 --> 00:24:38,069 THERE ARE SEVERAL DIFFERENT 601 00:24:38,069 --> 00:24:39,837 OPPORTUNITIES HERE TO ADVANCE 602 00:24:39,837 --> 00:24:43,007 THE MEASUREMENT AND RESEARCH 603 00:24:43,007 --> 00:24:47,011 OF MULTITEAMS SYSTEMS AND 604 00:24:47,011 --> 00:24:47,512 MULTIMORBIDITIES. 605 00:24:47,512 --> 00:24:49,113 WE SEARCHED PRETTY HARD TO 606 00:24:49,113 --> 00:24:50,715 FIND ADDITIONAL MEASURES OF 607 00:24:50,715 --> 00:24:52,216 TEAM PROCESSES AND THEIRS WAS 608 00:24:52,216 --> 00:24:54,385 THE BEST HOWEVER A LOT OF 609 00:24:54,385 --> 00:25:02,326 THESE MEASURES ARE FACED WITH 610 00:25:02,326 --> 00:25:04,996 THE STEALING EFFECT PROCESS, 611 00:25:04,996 --> 00:25:06,964 MOST WERE SURVIVORS BUT HAVING 612 00:25:06,964 --> 00:25:08,099 ADVERSE EFFECTS FROM LIMITED 613 00:25:08,099 --> 00:25:10,301 CARE OR CARE COORDINATION, YOU 614 00:25:10,301 --> 00:25:13,504 CAN'T COLLECT DATA ON THAT SO 615 00:25:13,504 --> 00:25:16,474 FIRST WE GET THE STEALING 616 00:25:16,474 --> 00:25:18,075 EVENTS WERE PATIENTS WHO 617 00:25:18,075 --> 00:25:19,677 SURVIVED AND THEN JUST PATIENT 618 00:25:19,677 --> 00:25:21,746 REPORTED MEASURES OF TEAM WORK 619 00:25:21,746 --> 00:25:24,182 AND TEAM PROCESSES TEND TO BE 620 00:25:24,182 --> 00:25:25,683 MORE POSITIVELY RATED AND SO 621 00:25:25,683 --> 00:25:26,851 THAT CAN LIMIT YOUR 622 00:25:26,851 --> 00:25:29,287 VARIABILITY IN TERMS OF DOING 623 00:25:29,287 --> 00:25:31,322 QUANTITATIVE ANALYSIS AND 624 00:25:31,322 --> 00:25:32,323 MAKING INTERPRETATIONS OF WHAT 625 00:25:32,323 --> 00:25:35,126 IS GOING ON WHEN YOU ONLY USE 626 00:25:35,126 --> 00:25:38,629 THE JUAN TATIVE SIDE. 627 00:25:38,629 --> 00:25:40,164 SO I THOUGHT ABOUT DOING 628 00:25:40,164 --> 00:25:42,099 SOMETHING LIKE A SITUATIONAL 629 00:25:42,099 --> 00:25:43,935 ADJUSTMENT TEST WHERE YOU ARE 630 00:25:43,935 --> 00:25:46,671 DEFINING THE DIFFERENT ACTIONS 631 00:25:46,671 --> 00:25:48,873 THAT MIGHT OCCUR DURING A CARE 632 00:25:48,873 --> 00:25:50,808 COORDINATION MEETING OR THAT 633 00:25:50,808 --> 00:25:52,743 YOU MIGHT OBSERVE OVER YOUR 634 00:25:52,743 --> 00:25:54,812 CARE COORDINATION -- OR MIGHT 635 00:25:54,812 --> 00:25:57,215 OBSERVE OVER YOUR CARE PATHWAY 636 00:25:57,215 --> 00:25:58,249 TO ACTUALLY ASSESS THINGS 637 00:25:58,249 --> 00:26:00,351 BEING DONE RATHER THAN YOUR 638 00:26:00,351 --> 00:26:01,285 PERSPECTIVE IF THEY 639 00:26:01,285 --> 00:26:07,592 COMMUNICATED WELL AND IF THE 640 00:26:07,592 --> 00:26:09,193 TEAM HAD FOCUSED PERCEPTIONS. 641 00:26:09,193 --> 00:26:11,028 SO THAT IS WHERE I AM GOING 642 00:26:11,028 --> 00:26:12,430 FROM THE MEASUREMENT SIDE AND 643 00:26:12,430 --> 00:26:15,433 FROM THE RESEARCH SIDE, I AM 644 00:26:15,433 --> 00:26:18,302 HOPING TO IMPLEMENT A SIMILAR 645 00:26:18,302 --> 00:26:20,037 STUDY HERE AT UNIVERSITY OF 646 00:26:20,037 --> 00:26:21,639 NEBRASKA MEDS SEASON SO 647 00:26:21,639 --> 00:26:25,142 WORKING WITH FOLKS AT THE 648 00:26:25,142 --> 00:26:27,111 SURVIVORSHIP CLINIC TO SURVEY 649 00:26:27,111 --> 00:26:28,713 THEIR PATIENT REPORTED 650 00:26:28,713 --> 00:26:30,781 OUTCOMES AND SEEING HOW THAT 651 00:26:30,781 --> 00:26:32,450 TRANSITION PROCESS FROM END OF 652 00:26:32,450 --> 00:26:34,018 CANCER TREATMENT BACK TO 653 00:26:34,018 --> 00:26:34,952 PRIMARY CARE TAKES PLACE 654 00:26:34,952 --> 00:26:36,787 BECAUSE THERE IS A LOT OF 655 00:26:36,787 --> 00:26:40,891 DELAYS AND ISSUES WITH THAT AS 656 00:26:40,891 --> 00:26:41,259 WELL. 657 00:26:41,259 --> 00:26:44,962 IN TERMS OF SOME REFLECTIONS 658 00:26:44,962 --> 00:26:46,931 AND OPPORTUNITIES, I MENTIONED 659 00:26:46,931 --> 00:26:49,634 BEFORE THAT THERE WERE LIMITED 660 00:26:49,634 --> 00:26:51,569 POWER ISSUES THAT WE HAD 661 00:26:51,569 --> 00:26:53,204 RELATED TO PROLIFIC AND THEN 662 00:26:53,204 --> 00:26:54,939 WE SWITCHED OVER TO CLOUD 663 00:26:54,939 --> 00:26:55,806 RESEARCH. 664 00:26:55,806 --> 00:26:56,440 THIS RESEARCH IS REALLY 665 00:26:56,440 --> 00:26:59,210 DIFFICULT TO DO IF YOU WANT TO 666 00:26:59,210 --> 00:27:01,379 OVER-SAMPLE RACIAL AND ETHNIC 667 00:27:01,379 --> 00:27:04,015 MINORITIES ON THESE ONLINE 668 00:27:04,015 --> 00:27:04,515 SURVEY PLATFORMS. 669 00:27:04,515 --> 00:27:07,318 SO WHEN I INITIALLY DID POWER 670 00:27:07,318 --> 00:27:09,287 ANALYSIS ON WHAT WAS REPORTED 671 00:27:09,287 --> 00:27:11,555 TO BE AVAILABLE, IT SAID THERE 672 00:27:11,555 --> 00:27:12,590 WOULD BE SUFFICIENT SAMPLE 673 00:27:12,590 --> 00:27:15,459 INDIVIDUALS FOR OUR STUDY ON 674 00:27:15,459 --> 00:27:16,661 PROLIFIC HOWEVER THAT WASN'T 675 00:27:16,661 --> 00:27:18,496 REALLY THE CASE AND THEN WHEN 676 00:27:18,496 --> 00:27:20,598 I REACHED OUT TO CLOUD 677 00:27:20,598 --> 00:27:23,367 RESEARCH TO DO OUR STUDY, THEY 678 00:27:23,367 --> 00:27:25,603 QUOTED ME INITIALLY ALMOST TWO 679 00:27:25,603 --> 00:27:27,571 OR THREE TIMES MY BUDGET AND I 680 00:27:27,571 --> 00:27:29,774 HAD TO NEGOTIATE BACK AND 681 00:27:29,774 --> 00:27:32,710 FORTH SO UNFORTUNATELY WE 682 00:27:32,710 --> 00:27:34,245 WEREN'T ABLE TO OVER-SAMPLE 683 00:27:34,245 --> 00:27:35,946 THE RACIAL AND ETHNIC 684 00:27:35,946 --> 00:27:37,348 MINORITIES DUE TO THE 685 00:27:37,348 --> 00:27:38,516 FINANCIAL COSTS AFFILIATED 686 00:27:38,516 --> 00:27:40,918 WITH TRYING TO RECRUIT THESE 687 00:27:40,918 --> 00:27:42,753 VIA THESE PLATFORMS SO I DO 688 00:27:42,753 --> 00:27:44,588 THINK THAT IS ONE, I GUESS, 689 00:27:44,588 --> 00:27:46,290 CONSIDERATION IF YOU ARE 690 00:27:46,290 --> 00:27:47,792 THINKING ABOUT DOING SOMETHING 691 00:27:47,792 --> 00:27:49,694 SIMILAR TO THIS STUDY AND 692 00:27:49,694 --> 00:27:52,863 THEN, YEAH, I THINK THOSE ARE 693 00:27:52,863 --> 00:27:53,564 THE MAIN REFLECTIONS THAT I 694 00:27:53,564 --> 00:27:55,666 HAVE RELATED TO BOTH THE 695 00:27:55,666 --> 00:27:57,268 MEASUREMENT OF TEAM COMPLEXITY 696 00:27:57,268 --> 00:27:59,370 AND THE DIFFERENT ONLINE 697 00:27:59,370 --> 00:28:00,171 SURVEY PLATFORMS. 698 00:28:00,171 --> 00:28:02,440 AND THEN FINALLY I WOULD LIKE 699 00:28:02,440 --> 00:28:06,844 TO THANK MY COLLABORATORS, 700 00:28:06,844 --> 00:28:16,153 Dr. MICHELLE DOOSE, SALLIE 701 00:28:16,153 --> 00:28:21,125 WEAVER, VERONICA SHELLETT AND 702 00:28:21,125 --> 00:28:24,729 JANET SANCHEZ. 703 00:28:24,729 --> 00:28:28,065 >> THANK YOU, DANA. 704 00:28:28,065 --> 00:28:31,535 A VERY INTERESTING 705 00:28:31,535 --> 00:28:33,237 PRESENTATION IN THE WAY IS A 706 00:28:33,237 --> 00:28:34,405 PROCESS WE DON'T REALLY 707 00:28:34,405 --> 00:28:35,339 UNDERSTAND UNTIL YOU ARE IN 708 00:28:35,339 --> 00:28:36,841 THE SYSTEM OF WORKING WITH 709 00:28:36,841 --> 00:28:39,009 THESE TEAMS AND THEN YOU 710 00:28:39,009 --> 00:28:42,847 REALIZE HOW COMPLICATED THINGS 711 00:28:42,847 --> 00:28:44,882 ARE AND THAT SYSTEMS FROM 712 00:28:44,882 --> 00:28:47,885 PERSONAL EXPERIENCE OF, YOU 713 00:28:47,885 --> 00:28:50,888 KNOW, CARING FOR MY RELATIVE 714 00:28:50,888 --> 00:28:51,555 UNDERGOING CANCER TREATMENT 715 00:28:51,555 --> 00:28:53,524 AND ALL THE END OF LIFE 716 00:28:53,524 --> 00:28:55,359 DECISIONS AND ALL THAT KIND OF 717 00:28:55,359 --> 00:28:57,128 THINGS, IT IS LIKE WHO AM I 718 00:28:57,128 --> 00:28:59,663 SUPPOSED TO TALK TO, WHY AM I 719 00:28:59,663 --> 00:29:00,965 TALKING TO THESE PEOPLE AND I 720 00:29:00,965 --> 00:29:02,700 ALWAYS FIND IT VERY CONFUSING 721 00:29:02,700 --> 00:29:04,034 SO I APPRECIATE THE WORK THAT 722 00:29:04,034 --> 00:29:04,835 YOU ARE DOING. 723 00:29:04,835 --> 00:29:06,203 A FEW QUESTIONS I HAVE AND 724 00:29:06,203 --> 00:29:09,774 THOSE FOLKS WHO ARE WATCHING 725 00:29:09,774 --> 00:29:12,109 ONLINE, YOU CAN CERTAINLY 726 00:29:12,109 --> 00:29:14,745 E-MAIL THE E-MAIL PROVIDED ON 727 00:29:14,745 --> 00:29:16,347 THE VIDEOCAST AND ASK YOUR 728 00:29:16,347 --> 00:29:18,916 QUESTION AS WELL AND I THINK 729 00:29:18,916 --> 00:29:20,751 IT IS UNFORTUNATE BECAUSE THE 730 00:29:20,751 --> 00:29:23,654 CHANGE IN THE SURVEY PLATFORM 731 00:29:23,654 --> 00:29:25,656 YOU WEREN'T ABLE TO COLLECT 732 00:29:25,656 --> 00:29:28,359 ANY SUBSTANTIAL PROPORTION OF 733 00:29:28,359 --> 00:29:29,860 RACIAL MINORITIES AND 734 00:29:29,860 --> 00:29:30,828 DISBANDED POPULATIONS BUT IT 735 00:29:30,828 --> 00:29:32,663 SEEMS LIKE YOU HAVE SOME OF 736 00:29:32,663 --> 00:29:34,231 THEM AND I AM PARTICULARLY 737 00:29:34,231 --> 00:29:35,633 INTERESTED IN YOUR COMMENT, 738 00:29:35,633 --> 00:29:37,802 YOU SAID YOU LOOKED AT SOME OF 739 00:29:37,802 --> 00:29:39,537 THE RESPONSES AND THERE WERE 740 00:29:39,537 --> 00:29:44,341 SOME DIFFERENCES IN TERMS OF 741 00:29:44,341 --> 00:29:46,377 RACE, ETHNICITY AND SEXUAL 742 00:29:46,377 --> 00:29:48,779 GENDER IDENTITY AND THERE MAY 743 00:29:48,779 --> 00:29:50,981 OR MAY NOT BE REAL YOUR BEEN 744 00:29:50,981 --> 00:29:51,982 DIFFERENCES. 745 00:29:51,982 --> 00:29:53,517 CAN YOU EXPLAIN A LITTLE BIT 746 00:29:53,517 --> 00:29:55,453 MORE ABOUT THAT AND DO YOU 747 00:29:55,453 --> 00:29:59,089 ALSO SEE THOSE DIFFERENCES IN 748 00:29:59,089 --> 00:30:00,357 THE QUALITATIVE DATA YOU HAVE 749 00:30:00,357 --> 00:30:01,058 COLLECTED? 750 00:30:01,058 --> 00:30:03,027 >> I WILL START WITH THE 751 00:30:03,027 --> 00:30:04,261 QUALITATIVE PIECE ACTUALLY. 752 00:30:04,261 --> 00:30:05,896 SO WHEN WE WERE SWITCHING 753 00:30:05,896 --> 00:30:08,065 PLATFORMS, I INITIALLY WANTED 754 00:30:08,065 --> 00:30:12,470 TO ALSO ONLY INTERVIEW RACIAL 755 00:30:12,470 --> 00:30:15,773 AND ETHNIC MINORITIES OR 756 00:30:15,773 --> 00:30:17,374 SEXUAL AND GENDER MINORITIES 757 00:30:17,374 --> 00:30:19,810 AND THOSE FROM RURAL AREAS SO 758 00:30:19,810 --> 00:30:22,813 USING THE NIH DEFINITION OF 759 00:30:22,813 --> 00:30:24,515 THOSE DISPARITY POPULATIONS. 760 00:30:24,515 --> 00:30:30,688 AND SO I INITIALLY E-MAILED 761 00:30:30,688 --> 00:30:32,189 VIA PROLIFIC'S SECURE 762 00:30:32,189 --> 00:30:32,990 MESSAGING SYSTEM, THOSE 763 00:30:32,990 --> 00:30:35,426 INDIVIDUALS THAT DID 764 00:30:35,426 --> 00:30:36,227 SELF-IDENTIFY. 765 00:30:36,227 --> 00:30:37,361 HOWEVER I E-MAILED THEM 766 00:30:37,361 --> 00:30:39,897 PROBABLY A FEW TIMES AND 767 00:30:39,897 --> 00:30:40,698 WASN'T GETTING RESPONSES SO 768 00:30:40,698 --> 00:30:43,834 THEN I AGAIN HAD TO BROADEN 769 00:30:43,834 --> 00:30:45,069 THE SCOPE. 770 00:30:45,069 --> 00:30:46,737 SO I THINK 83 OR SO 771 00:30:46,737 --> 00:30:47,705 INDIVIDUALS INDICATED THEY 772 00:30:47,705 --> 00:30:50,140 WOULD BE OPEN TO BEING 773 00:30:50,140 --> 00:30:52,643 RE-CONTACTED FOR AN INTERVIEW 774 00:30:52,643 --> 00:30:53,644 VIA PROLIFIC. 775 00:30:53,644 --> 00:30:55,279 SO I RE-CONTACTED ALL OF THEM 776 00:30:55,279 --> 00:30:58,048 AND WE TOOK THE FIRST 12 THAT 777 00:30:58,048 --> 00:30:59,149 RESPONDED. 778 00:30:59,149 --> 00:30:59,884 HOWEVER, WITH THAT, I THINK 779 00:30:59,884 --> 00:31:02,086 MAYBE ONE OTHER PERSON HAD 780 00:31:02,086 --> 00:31:05,022 RESPONDED OUT OF THOSE 89 TO 781 00:31:05,022 --> 00:31:07,691 BE INTERVIEWED. 782 00:31:07,691 --> 00:31:10,060 SO-- AND THERE WAS LIMITED, I 783 00:31:10,060 --> 00:31:11,662 GUESS, REPRESENTATION FROM 784 00:31:11,662 --> 00:31:13,631 THAT GROUP THAT DID FOLLOW UP. 785 00:31:13,631 --> 00:31:15,900 THERE WERE A COUPLE BUT AGAIN 786 00:31:15,900 --> 00:31:19,069 NOT ENOUGH TO DO ANYTHING OF 787 00:31:19,069 --> 00:31:19,937 POWER, RIGHT? 788 00:31:19,937 --> 00:31:21,505 JUST BECAUSE IT IS SUCH A 789 00:31:21,505 --> 00:31:22,673 LIMITED SAMPLE AND I WOULD SAY 790 00:31:22,673 --> 00:31:26,310 THAT IS THE SAME ISSUE WITH 791 00:31:26,310 --> 00:31:29,980 THE DIFFERENCES BY RACE AND 792 00:31:29,980 --> 00:31:31,215 ETHNICITY AND SEXUAL AND 793 00:31:31,215 --> 00:31:32,049 GENDER MINORITIES. 794 00:31:32,049 --> 00:31:34,451 SO WE HAD A -- THIS PAPER IS 795 00:31:34,451 --> 00:31:37,221 ACTUALLY IN PRESS RIGHT NOW SO 796 00:31:37,221 --> 00:31:39,156 IT WAS RECENTLY ACCEPTED AT 797 00:31:39,156 --> 00:31:40,758 THE JOURNAL OF CANCER 798 00:31:40,758 --> 00:31:42,593 SURVIVORSHIP AND ONE OF THE 799 00:31:42,593 --> 00:31:44,328 REVIEWERS SAID THEY THOUGHT IT 800 00:31:44,328 --> 00:31:45,930 WAS A REALLY GOOD OPPORTUNITY 801 00:31:45,930 --> 00:31:48,699 TO EXPAND ON THE SEXUAL AND 802 00:31:48,699 --> 00:31:50,868 BENDER MINORITIES OR RACIAL 803 00:31:50,868 --> 00:31:51,969 AND ETHNIC MINORITIES BUT WE 804 00:31:51,969 --> 00:31:53,804 DON'T HAVE THE POWER TO DELVE 805 00:31:53,804 --> 00:31:55,673 INTO THAT IN A MEANINGFUL WAY. 806 00:31:55,673 --> 00:31:58,509 SO I THINK WHILE WE DID FIND 807 00:31:58,509 --> 00:32:00,511 DIFFERENCES FROM A STATISTICAL 808 00:32:00,511 --> 00:32:01,278 STANDPOINT, THERE IS 809 00:32:01,278 --> 00:32:03,547 LIMITATIONS ON WHAT WE CAN 810 00:32:03,547 --> 00:32:05,182 TAKE AWAY FROM THOSE 811 00:32:05,182 --> 00:32:07,918 DIFFERENCE WE DID DETECT. 812 00:32:07,918 --> 00:32:10,788 >> MM-HMM, DO YOU HAVE -- SO 813 00:32:10,788 --> 00:32:11,855 IT IS INTERESTING, ALSO 814 00:32:11,855 --> 00:32:13,090 LISTENING TO YOUR 815 00:32:13,090 --> 00:32:15,693 PRESENTATION, IT SEEMS LIKE 816 00:32:15,693 --> 00:32:17,628 THERE IS LIKE TWO TALES OF THE 817 00:32:17,628 --> 00:32:18,228 PATIENT EXPERIENCE. 818 00:32:18,228 --> 00:32:19,263 THERE IS SOME -- 819 00:32:19,263 --> 00:32:20,898 >> THAT IS HOW I FEEL. 820 00:32:20,898 --> 00:32:22,099 >> SOME THAT HAVE -- AND I 821 00:32:22,099 --> 00:32:23,233 DON'T KNOW IF THEY ARE 822 00:32:23,233 --> 00:32:24,501 DIFFERENT PEOPLE OR THEY MIGHT 823 00:32:24,501 --> 00:32:28,238 BE THE SAME PERSON HAVING TWO 824 00:32:28,238 --> 00:32:30,541 SEPARATE EXPERIENCE DURING THE 825 00:32:30,541 --> 00:32:32,343 SAME SYSTEM AND THERE ARE SOME 826 00:32:32,343 --> 00:32:36,180 THAT SEEM TO EXPERIENCE LIKE 827 00:32:36,180 --> 00:32:37,348 HIGH FUNCTIONING TEAMS THAT 828 00:32:37,348 --> 00:32:39,750 ARE TAKING CARE OF THEIR 829 00:32:39,750 --> 00:32:41,218 TREATMENTS AND THINGS ALTHOUGH 830 00:32:41,218 --> 00:32:42,052 CERTAINLY THERE ARE SOME 831 00:32:42,052 --> 00:32:44,021 REPORTING THAT EVERYTHING IS 832 00:32:44,021 --> 00:32:45,623 CONFUSING, THEY HAVE TO FIGHT 833 00:32:45,623 --> 00:32:47,024 FOR THEMSELVES AND WHAT THEY 834 00:32:47,024 --> 00:32:49,793 SEE ON LIKE TV SHOW IS NOT 835 00:32:49,793 --> 00:32:50,160 HAPPENING. 836 00:32:50,160 --> 00:32:52,796 AND THEN ON THE OTHER HAND, 837 00:32:52,796 --> 00:32:56,300 YOU HAVE EVEN THOSE WHO HAVE 838 00:32:56,300 --> 00:32:58,268 BEEN FEELING LIKE THEY HAVE 839 00:32:58,268 --> 00:33:00,704 BEEN TAKEN CARE OF ON THE 840 00:33:00,704 --> 00:33:01,739 TREATMENT SIDE, THE 841 00:33:01,739 --> 00:33:02,940 DECISION-MAKING RESPECT IS NOT 842 00:33:02,940 --> 00:33:03,240 THERE. 843 00:33:03,240 --> 00:33:04,875 >> I THINK THERE IS A REALLY 844 00:33:04,875 --> 00:33:06,043 INTERESTING STORY ALSO TO BE 845 00:33:06,043 --> 00:33:07,678 TOLD FOR THOSE THAT HAVE THE 846 00:33:07,678 --> 00:33:09,213 ABILITY TO GET SECOND 847 00:33:09,213 --> 00:33:09,680 OPINIONS, RIGHT? 848 00:33:09,680 --> 00:33:11,081 SO THERE WERE A COUPLE OF 849 00:33:11,081 --> 00:33:13,283 PEOPLE WE INTERVIEWED THAT HAD 850 00:33:13,283 --> 00:33:13,984 REALLY NEGATIVE INTERACTIONS 851 00:33:13,984 --> 00:33:15,786 WITH THE CARE TEAM AND THEN 852 00:33:15,786 --> 00:33:16,720 THEY WENT SOMEWHERE ELSE AND 853 00:33:16,720 --> 00:33:18,022 THEN IT WAS GREAT. 854 00:33:18,022 --> 00:33:19,857 SO WHEN THEY REFLECTED ON 855 00:33:19,857 --> 00:33:21,392 THEIR CARE COORDINATION OR 856 00:33:21,392 --> 00:33:23,360 TEAM WORK, THEY REFLECTED ON 857 00:33:23,360 --> 00:33:24,628 THE POSITIVE EXPERIENCE OF THE 858 00:33:24,628 --> 00:33:26,463 TEAM THEY WENT WITH BUT THOSE 859 00:33:26,463 --> 00:33:27,731 ARE ONLY THE INDIVIDUALS THAT 860 00:33:27,731 --> 00:33:30,501 WERE ABLE TO TAKE OFF WORK, TO 861 00:33:30,501 --> 00:33:32,536 TRAVEL ELSEWHERE, TO DO AND 862 00:33:32,536 --> 00:33:34,738 GET ALL THOSE SECOND OPINIONS. 863 00:33:34,738 --> 00:33:36,774 SO I THINK THAT SOMETHING I 864 00:33:36,774 --> 00:33:41,645 HAVE THOUGHT ABOUT IS THERE IS 865 00:33:41,645 --> 00:33:45,849 WAYS TO LOOK AT, LIKE SEE YOUR 866 00:33:45,849 --> 00:33:47,918 MEDICAL CARE AND THE DIFFERENT 867 00:33:47,918 --> 00:33:48,919 MEDICAL APPOINTMENTS YOU HAD 868 00:33:48,919 --> 00:33:50,554 BEGINNING TREATMENT, IF YOU 869 00:33:50,554 --> 00:33:51,355 ARE CHANGING FACILITIES, 870 00:33:51,355 --> 00:33:52,489 SOMETHING LIKE THAT BECAUSE 871 00:33:52,489 --> 00:33:54,591 THAT IS LIKE AN INTERESTING 872 00:33:54,591 --> 00:33:56,560 ASPECT I HAD NOT REALLY 873 00:33:56,560 --> 00:33:57,961 THOUGHT ABOUT UNTIL 874 00:33:57,961 --> 00:33:58,996 INTERVIEWING FOLKS. 875 00:33:58,996 --> 00:34:01,865 AND YES I AGREE THERE IS 876 00:34:01,865 --> 00:34:04,134 REALLY KIND OF THIS TALE OF 877 00:34:04,134 --> 00:34:04,401 TWO. 878 00:34:04,401 --> 00:34:05,703 THERE IS THE PEOPLE THAT GET 879 00:34:05,703 --> 00:34:08,105 IT AND I THINK THERE'S A 880 00:34:08,105 --> 00:34:11,208 SYSTEM AND TEAM THING SO ONE 881 00:34:11,208 --> 00:34:13,410 OF MY QUESTIONS IS ARE THE 882 00:34:13,410 --> 00:34:15,212 PLACES THAT HAVE REALLY 883 00:34:15,212 --> 00:34:16,814 COORDINATED CARE, DO THEY 884 00:34:16,814 --> 00:34:19,049 TRAIN STAFF WHEN THEY COME IN 885 00:34:19,049 --> 00:34:22,152 AND SAY HERE IS THE MDC, HERE 886 00:34:22,152 --> 00:34:23,887 ARE THE TREATMENT GUIDELINES, 887 00:34:23,887 --> 00:34:25,622 DO WE FOLLOW THAT UP WITH 888 00:34:25,622 --> 00:34:26,890 PATIENTS AND IMPLEMENT THAT 889 00:34:26,890 --> 00:34:29,493 FROM THE STRUCTURAL AND 890 00:34:29,493 --> 00:34:30,327 INTERPERSONAL SIDE. 891 00:34:30,327 --> 00:34:31,695 BECAUSE OTHER FOLKS HAVE 892 00:34:31,695 --> 00:34:34,364 REPORTED THAT, AS YOU SAID, IT 893 00:34:34,364 --> 00:34:35,199 IS VERY SEQUENTIAL, THERE WAS 894 00:34:35,199 --> 00:34:36,467 NO TREATMENT PLAN AND I HAVE 895 00:34:36,467 --> 00:34:38,769 SEEN THAT WITHIN OUR 896 00:34:38,769 --> 00:34:39,803 INSTITUTION, DIFFERENT 897 00:34:39,803 --> 00:34:40,838 PROVIDERS FROM DIFFERENT 898 00:34:40,838 --> 00:34:43,507 SPECIALTIES SEE THE VALUE OF 899 00:34:43,507 --> 00:34:44,541 THE MULTIDISCIPLINARY CLINIC 900 00:34:44,541 --> 00:34:44,908 OR DON'T. 901 00:34:44,908 --> 00:34:47,177 SO WE HAVE LIKE OUR BREAST 902 00:34:47,177 --> 00:34:49,012 CANCER TEAM HERE REALLY SEES 903 00:34:49,012 --> 00:34:52,983 THE VALUE OF MDC. 904 00:34:52,983 --> 00:34:56,353 THEY BRING ALL THEIR PATIENTS 905 00:34:56,353 --> 00:35:01,225 IN TO IT, THEY TAKE PLACE IN 906 00:35:01,225 --> 00:35:02,726 SHARED DECISION-MAKING AND 907 00:35:02,726 --> 00:35:04,228 SOME CANCERS DON'T. 908 00:35:04,228 --> 00:35:05,496 >> YEAH, IT SEEMS LIKE THERE 909 00:35:05,496 --> 00:35:08,031 IS A LOT TO EXPLORE ON THE 910 00:35:08,031 --> 00:35:09,767 TYPE OF CANCER BEING TREATED, 911 00:35:09,767 --> 00:35:12,770 YOU KNOW, BREAST CANCER VERSUS 912 00:35:12,770 --> 00:35:14,404 LIVER CANCER VERSUS KIDNEY 913 00:35:14,404 --> 00:35:17,040 CANCER AND THAT MIGHT BE QUITE 914 00:35:17,040 --> 00:35:19,309 DIFFERENT AS TO HOW TO 915 00:35:19,309 --> 00:35:20,577 ORGANIZE THAT TREATMENT PLAN 916 00:35:20,577 --> 00:35:24,948 AND THE TREATMENT OPTIONS THAT 917 00:35:24,948 --> 00:35:26,450 THEY ARE -- FOR PEOPLE TO 918 00:35:26,450 --> 00:35:29,052 CONSIDER IN THE STAGES OF 919 00:35:29,052 --> 00:35:30,053 DIAGNOSES THAT MAY BE 920 00:35:30,053 --> 00:35:30,621 DIFFERENT. 921 00:35:30,621 --> 00:35:32,456 ARE YOU ABLE TO LOOK AT SOME 922 00:35:32,456 --> 00:35:33,357 OF THOSE ISSUES? 923 00:35:33,357 --> 00:35:36,860 FOR EXAMPLE, DO YOU FIND THAT 924 00:35:36,860 --> 00:35:39,029 BREAST CANCER, PATIENTS WITH 925 00:35:39,029 --> 00:35:40,297 SURVIVAL BREAST CANCER ARE 926 00:35:40,297 --> 00:35:42,032 ACTUALLY HAVING A BETTER 927 00:35:42,032 --> 00:35:43,967 EXPERIENCE VERSUS SOME OTHER 928 00:35:43,967 --> 00:35:47,604 TYPE OF CANCER OR DIFFERENT 929 00:35:47,604 --> 00:35:50,574 STAGE OF THAT DIAGNOSES HAVE 930 00:35:50,574 --> 00:35:51,141 DIFFERENT EXPERIENCE? 931 00:35:51,141 --> 00:35:52,409 >> THE DIFFERENT CANCER TYPES, 932 00:35:52,409 --> 00:35:54,311 I DON'T THINK I LOOKED INTO. 933 00:35:54,311 --> 00:35:55,946 I DID LOOK INTO THE STAGING 934 00:35:55,946 --> 00:35:59,616 AND DON'T THINK I HAVE THOSE 935 00:35:59,616 --> 00:36:00,317 SUPPLEMENTAL ANALYSES. 936 00:36:00,317 --> 00:36:02,920 ONE OF THE THINGS WE DID LOOK 937 00:36:02,920 --> 00:36:03,987 AT THAT I REMEMBER FROM THE 938 00:36:03,987 --> 00:36:06,757 TOP OF MY HEAD WAS LOOKING AT 939 00:36:06,757 --> 00:36:07,891 TIME DIAGNOSIS, THOSE THAT 940 00:36:07,891 --> 00:36:09,760 WERE FURTHER AND FURTHER AWAY 941 00:36:09,760 --> 00:36:13,530 FROM THEIR DIAGNOSIS TENDED TO 942 00:36:13,530 --> 00:36:15,933 REFLECT MORE POSITIVE OR 943 00:36:15,933 --> 00:36:18,101 HIGHER RATINGS OF PERCEIVED 944 00:36:18,101 --> 00:36:19,036 TEAM EFFECTIVENESS WHICH I 945 00:36:19,036 --> 00:36:20,404 THINK MAKES SENSE, RIGHT? 946 00:36:20,404 --> 00:36:23,507 SO IF YOU LIVED LONGER THAN 947 00:36:23,507 --> 00:36:25,475 YOU MAYBE INITIALLY THOUGHT OR 948 00:36:25,475 --> 00:36:27,778 LONGER IN GENERAL, YOU REFLECT 949 00:36:27,778 --> 00:36:29,947 MORE POSITIVELY ON THAT 950 00:36:29,947 --> 00:36:30,514 EXPERIENCE. 951 00:36:30,514 --> 00:36:32,149 STAGING, I AM NOT SURE WHAT WE 952 00:36:32,149 --> 00:36:33,784 FOUND WITH THAT ONE THOUGH. 953 00:36:33,784 --> 00:36:36,186 >> AND I THINK THE OTHER PART 954 00:36:36,186 --> 00:36:37,721 IS PROBABLY WHERE YOU HAVE 955 00:36:37,721 --> 00:36:39,456 A -- UNFORTUNATELY THERE IS A 956 00:36:39,456 --> 00:36:41,658 SURVIVAL BIAS HERE, TOO. 957 00:36:41,658 --> 00:36:43,360 SO PEOPLE WHO UNFORTUNATELY 958 00:36:43,360 --> 00:36:44,428 DIDN'T SURVIVE COULDN'T 959 00:36:44,428 --> 00:36:46,263 PROVIDE THE INFORMATION AND SO 960 00:36:46,263 --> 00:36:48,866 THAT IS A ENTIRE SET OF 961 00:36:48,866 --> 00:36:50,067 CONSIDERATION EXPERIENCE THAT 962 00:36:50,067 --> 00:36:51,735 WE COULDN'T GET TO HEAR. 963 00:36:51,735 --> 00:36:54,938 I ALSO WANT TO ASK YOU, HAVE 964 00:36:54,938 --> 00:36:57,107 YOU -- KNOWING WHAT YOU KNOW 965 00:36:57,107 --> 00:36:59,076 NOW THROUGH THIS STUDY, HAVE 966 00:36:59,076 --> 00:37:00,477 YOU TALKED TO HEALTHCARE TEAMS 967 00:37:00,477 --> 00:37:02,312 ABOUT HOW THEY SEE THIS -- 968 00:37:02,312 --> 00:37:03,480 LIKE HOW PATIENTS SEE THEM IN 969 00:37:03,480 --> 00:37:08,518 TERMS OF THE TWO SET OF 970 00:37:08,518 --> 00:37:11,355 EXPERIENCES, LIKE TOO MANY 971 00:37:11,355 --> 00:37:11,989 EFFECTIVENESS COORDINATE 972 00:37:11,989 --> 00:37:14,191 NATIONS, THAT MIGHT BE GOOD 973 00:37:14,191 --> 00:37:14,958 BUT SHARED DECISION-MAKING, 974 00:37:14,958 --> 00:37:16,627 HAVING RESPECT FOR THE 975 00:37:16,627 --> 00:37:18,128 PATIENT, NOT SO MUCH. 976 00:37:18,128 --> 00:37:20,097 SO WHAT DO THEY THINK? 977 00:37:20,097 --> 00:37:21,732 >> THAT IS WHAT I AM TRYING TO 978 00:37:21,732 --> 00:37:22,633 DO RIGHT NOW. 979 00:37:22,633 --> 00:37:24,601 I HAVE STRUGGLED HERE 980 00:37:24,601 --> 00:37:26,436 TRANSPARENTLY TO GET IT 981 00:37:26,436 --> 00:37:29,640 INTEGRATED IN THE HEALTHCARE 982 00:37:29,640 --> 00:37:29,973 SYSTEM. 983 00:37:29,973 --> 00:37:34,845 AT NCI I DID WORK WITH PRISMA 984 00:37:34,845 --> 00:37:35,679 HEALTH IN GREENVILLE, SOUTH 985 00:37:35,679 --> 00:37:37,681 CAROLINA WITH THEIR CANCER 986 00:37:37,681 --> 00:37:38,982 CARE CLINIC AND VERY 987 00:37:38,982 --> 00:37:41,652 INTERESTED IN WORKING TOGETHER 988 00:37:41,652 --> 00:37:42,753 RELATED TO MULTIDISCIPLINARY 989 00:37:42,753 --> 00:37:44,421 CARE AND TEAM COORDINATION. 990 00:37:44,421 --> 00:37:47,157 BUT I HAVE STRUGGLED A LITTLE 991 00:37:47,157 --> 00:37:48,759 BIT ANSWERING SOME OF THOSE 992 00:37:48,759 --> 00:37:50,260 QUESTIONS I AM INTERESTED IN 993 00:37:50,260 --> 00:37:52,095 LOOKING AT BECAUSE I KNOW FROM 994 00:37:52,095 --> 00:37:54,031 TALKING WITH FOLKS THAT THERE 995 00:37:54,031 --> 00:37:56,433 ARE CLINICS, LIKE OUR BREAST 996 00:37:56,433 --> 00:37:58,769 CANCER CLINIC DOES HAVE A 997 00:37:58,769 --> 00:38:01,371 MULTIDISCIPLINARY TEAM, THEY 998 00:38:01,371 --> 00:38:02,773 ARE ACTIVELY WORKING AS A TEAM 999 00:38:02,773 --> 00:38:04,541 AND THEN THERE ARE OTHER 1000 00:38:04,541 --> 00:38:05,108 CLINICS WHO AREN'T. 1001 00:38:05,108 --> 00:38:07,344 SO I AM INTERESTED IN LOOKING 1002 00:38:07,344 --> 00:38:09,913 AT THE CARE PATHWAYS FROM OUR 1003 00:38:09,913 --> 00:38:12,316 DATA SIDE SO REQUESTING OUR 1004 00:38:12,316 --> 00:38:15,652 MEDICAL RECORDS TO LOOK AT THE 1005 00:38:15,652 --> 00:38:18,155 CARE TRAJECTORIES AND DELAYS 1006 00:38:18,155 --> 00:38:19,690 IN CARE FOR THOSE CANCERS THAT 1007 00:38:19,690 --> 00:38:22,759 I HAVE BEEN TOLD HAVE 1008 00:38:22,759 --> 00:38:23,894 CHALLENGES HERE TO SEE IF 1009 00:38:23,894 --> 00:38:27,564 THERE ARE MORE DELAYS OR 1010 00:38:27,564 --> 00:38:28,265 DIFFERENT TREATMENT OUTCOMES. 1011 00:38:28,265 --> 00:38:30,934 I THINK SOME PROVIDERS HAVE AN 1012 00:38:30,934 --> 00:38:32,369 ISSUE WITH IT AND SOME DON'T 1013 00:38:32,369 --> 00:38:34,304 SO THEY DON'T THINK SOME OF 1014 00:38:34,304 --> 00:38:36,039 THOSE COORDINATION THINGS ARE 1015 00:38:36,039 --> 00:38:36,740 THEIR RESPONSIBILITY AND THAT 1016 00:38:36,740 --> 00:38:38,342 IS WHY I AM INTERESTED IN 1017 00:38:38,342 --> 00:38:40,210 ASKING THE PROVIDERS THAT DO 1018 00:38:40,210 --> 00:38:43,347 SEE IT AS SOME KIND OF 1019 00:38:43,347 --> 00:38:44,481 ORGANIZATIONAL TRAINING, IS IT 1020 00:38:44,481 --> 00:38:46,116 SOMETHING THEY GOT WHILE THEY 1021 00:38:46,116 --> 00:38:47,884 WERE A MEDICAL RESIDENT OR 1022 00:38:47,884 --> 00:38:52,589 FELLOW OR WHAT KIND OF DRIVE 1023 00:38:52,589 --> 00:38:53,757 THAT -- DRIVES THAT INTEREST 1024 00:38:53,757 --> 00:38:58,362 IN SEEING IT AS PART OF YOUR 1025 00:38:58,362 --> 00:39:00,263 PURVIEW, PER SE. 1026 00:39:00,263 --> 00:39:01,798 >> MM. 1027 00:39:01,798 --> 00:39:04,001 IT IS ALSO INTERESTING, IS 1028 00:39:04,001 --> 00:39:06,169 IT -- YOU KNOW AS YOU ARE 1029 00:39:06,169 --> 00:39:07,471 STUDYING STRUCTURAL AND SYSTEM 1030 00:39:07,471 --> 00:39:09,806 LEVEL FACTORS, IS IT THE BEST 1031 00:39:09,806 --> 00:39:12,809 FOR THE PHYSICIANS TO BE THE 1032 00:39:12,809 --> 00:39:14,711 CARE COORDINATOR? 1033 00:39:14,711 --> 00:39:17,647 OR SOME OF THESE PATIENTS 1034 00:39:17,647 --> 00:39:19,916 HAVE -- OR THEY HAVE HAD A 1035 00:39:19,916 --> 00:39:20,884 PATIENT NAVIGATOR, WOULD THAT 1036 00:39:20,884 --> 00:39:22,652 BE A DIFFERENT KIND OF 1037 00:39:22,652 --> 00:39:23,420 EXPERIENCE? 1038 00:39:23,420 --> 00:39:27,357 BECAUSE I DO FIND THAT BEING A 1039 00:39:27,357 --> 00:39:28,658 PATIENT OR FAMILY OF A 1040 00:39:28,658 --> 00:39:30,594 PATIENT, SOMETIMES IT IS HARD 1041 00:39:30,594 --> 00:39:33,096 TO ADVOCATE IN A WAY THAT IS 1042 00:39:33,096 --> 00:39:36,666 RECEPTIVE TO THE MEDICAL 1043 00:39:36,666 --> 00:39:38,835 SYSTEM AND A PATIENT CARE OR 1044 00:39:38,835 --> 00:39:40,604 PATIENT AND A HALF BARRETT WHO 1045 00:39:40,604 --> 00:39:42,973 IS AN ADVOCATE FOR THE PATIENT 1046 00:39:42,973 --> 00:39:45,042 WITHIN THE SYSTEM MAY DO A 1047 00:39:45,042 --> 00:39:48,111 BETTER JOB THAN THE PHYSICIANS 1048 00:39:48,111 --> 00:39:50,080 AND PROVIDERS WHO ARE SEEING 1049 00:39:50,080 --> 00:39:54,284 THIS PATIENT ADVOCATE ON A 1050 00:39:54,284 --> 00:39:57,187 DAY-TO-DAY BASIS AND MAY 1051 00:39:57,187 --> 00:39:59,022 ACTUALLY FACILITATE BETTER 1052 00:39:59,022 --> 00:40:00,023 COMMUNICATION. 1053 00:40:00,023 --> 00:40:02,459 >> YES, WE DID ASK IF ONE OF 1054 00:40:02,459 --> 00:40:05,662 THE PROVIDERS INCLUDED IN OUR 1055 00:40:05,662 --> 00:40:08,031 LIST FOR PATIENTS INDICATED 1056 00:40:08,031 --> 00:40:10,867 THEY HAD NURSE NAVIGATORS AND 1057 00:40:10,867 --> 00:40:13,537 WE DID LOOK AT THAT AND SEE IF 1058 00:40:13,537 --> 00:40:17,307 THERE WAS ANY IMPACT ON TEAM 1059 00:40:17,307 --> 00:40:18,675 EFFECTIVENESS VERSUS THOSE WHO 1060 00:40:18,675 --> 00:40:22,646 DIDN'T SO THERE'S BEEN SEVERAL 1061 00:40:22,646 --> 00:40:24,815 GRANTS AWARDED AND STUDIES 1062 00:40:24,815 --> 00:40:27,017 FOUND THAT IT CAN FACILITATE 1063 00:40:27,017 --> 00:40:28,485 SOME OF THESE ISSUES. 1064 00:40:28,485 --> 00:40:32,289 I THINK THE CAVEAT IS IF 1065 00:40:32,289 --> 00:40:35,459 PROVIDERS ARE THERE WITH A 1066 00:40:35,459 --> 00:40:37,094 NAVIGATOR OR THEY HELP 1067 00:40:37,094 --> 00:40:38,228 FACILITATE APPOINTMENTS AND 1068 00:40:38,228 --> 00:40:41,198 THINGS LIKE THAT OR IF THEY 1069 00:40:41,198 --> 00:40:41,798 SERVE ANOTHER FUNCTION. 1070 00:40:41,798 --> 00:40:44,701 SO WHEN I WAS WITH PRISMA 1071 00:40:44,701 --> 00:40:51,208 HEALTH AND WORKED WITH THE 1072 00:40:51,208 --> 00:40:54,611 ESOPHOGEAL TEAM THERE, THE 1073 00:40:54,611 --> 00:40:55,345 CARE COORDINATED ANSWERED 1074 00:40:55,345 --> 00:40:57,747 QUESTIONS BUT WHEN I MET WITH 1075 00:40:57,747 --> 00:40:59,182 THE CARE COORDINATORS, THEY 1076 00:40:59,182 --> 00:41:01,518 SAID NO THAT IS NOT MY JOB. 1077 00:41:01,518 --> 00:41:03,353 THEY GET THE DOCUMENTS READY 1078 00:41:03,353 --> 00:41:05,655 AND DO SOME SCHEDULING BUT IT 1079 00:41:05,655 --> 00:41:06,590 WASN'T WHAT THE PROVIDERS 1080 00:41:06,590 --> 00:41:06,923 THOUGHT. 1081 00:41:06,923 --> 00:41:12,462 SO I THINK THERE'S SOME 1082 00:41:12,462 --> 00:41:13,497 TERMINOLOGY ISSUES THERE. 1083 00:41:13,497 --> 00:41:15,332 [ LAUGHING ] 1084 00:41:15,332 --> 00:41:16,566 VERSUS CARE COORDINATION 1085 00:41:16,566 --> 00:41:18,201 VERSUS SCHEDULER AND SOCIAL 1086 00:41:18,201 --> 00:41:21,371 WORKER BUT BECAUSE THERE'S 1087 00:41:21,371 --> 00:41:22,272 THIS DIVERSITY ACROSS 1088 00:41:22,272 --> 00:41:23,874 DIFFERENT SYSTEMS THAT PEOPLE 1089 00:41:23,874 --> 00:41:27,077 HEAR THE TERM AND ASSUME YOUR 1090 00:41:27,077 --> 00:41:27,811 FUNCTIONS. 1091 00:41:27,811 --> 00:41:29,045 >> THAT IS UNFORTUNATE, THAT 1092 00:41:29,045 --> 00:41:29,779 IS UNFORTUNATE. 1093 00:41:29,779 --> 00:41:32,115 BECAUSE I DO THINK WHEN YOU 1094 00:41:32,115 --> 00:41:35,318 ARE DEALING WITH CANCER OR 1095 00:41:35,318 --> 00:41:37,554 COMPLICATED CHRONIC DISEASES 1096 00:41:37,554 --> 00:41:38,421 AND INVOLVING MULTIPLE 1097 00:41:38,421 --> 00:41:41,491 DISCIPLINES WERE THE PATIENT'S 1098 00:41:41,491 --> 00:41:43,226 PERSPECTIVE, IT IS ALMOST IN A 1099 00:41:43,226 --> 00:41:44,561 WASH. 1100 00:41:44,561 --> 00:41:46,763 THAT SO MANY SYSTEMS YOU ARE 1101 00:41:46,763 --> 00:41:50,033 DEALING WITH TODAY, YOU SEE A 1102 00:41:50,033 --> 00:41:54,905 NEUROLOGIST AND THEN TOMORROW 1103 00:41:54,905 --> 00:41:58,408 YOU SEE SOMEONE ELSE AND LIKE 1104 00:41:58,408 --> 00:42:00,143 ALL THESE QUESTIONS, IT SEEMS 1105 00:42:00,143 --> 00:42:02,212 LIKE NOBODY IS TRYING TO 1106 00:42:02,212 --> 00:42:04,648 ANSWER THOSE, LIKE DO I REALLY 1107 00:42:04,648 --> 00:42:05,782 NEED TO CONSIDER THE DOCTOR 1108 00:42:05,782 --> 00:42:09,452 AND THEN HOW IS THIS GOING TO 1109 00:42:09,452 --> 00:42:10,820 AFFECT MY BOTTOM LINE WITH WE 1110 00:42:10,820 --> 00:42:12,522 WANT TO OF CARE AND OFTENTIMES 1111 00:42:12,522 --> 00:42:14,391 THAT IS VERY CHALLENGING TO 1112 00:42:14,391 --> 00:42:17,027 MAKE A DECISION ON HOW TO GET 1113 00:42:17,027 --> 00:42:18,762 YOUR SCHEDULE TOGETHER AND HOW 1114 00:42:18,762 --> 00:42:19,963 TO PAY FOR THE TREATMENT AND 1115 00:42:19,963 --> 00:42:23,033 OF COURSE OUR SYSTEM IS NOT 1116 00:42:23,033 --> 00:42:26,002 VERY GOOD AT LETTING THE 1117 00:42:26,002 --> 00:42:27,270 PATIENT KNOW ACTUALLY HOW 1118 00:42:27,270 --> 00:42:28,438 RESPONSIBLE THEY ARE FOR 1119 00:42:28,438 --> 00:42:29,606 TREATMENT AND YOU GET THE 1120 00:42:29,606 --> 00:42:31,808 TREATMENT AND THEN END UP 1121 00:42:31,808 --> 00:42:33,276 GETTING THE BILL AND YOU ARE 1122 00:42:33,276 --> 00:42:35,679 LIKE THIS IS HOW MUCH I HAVE 1123 00:42:35,679 --> 00:42:36,746 TO PAY? 1124 00:42:36,746 --> 00:42:38,582 >> YES, AND THE SUSTAINED 1125 00:42:38,582 --> 00:42:39,516 EFFECTS OF THAT AS WELL. 1126 00:42:39,516 --> 00:42:42,285 SO I AM WORKING WITH A 1127 00:42:42,285 --> 00:42:44,287 COLLEAGUE HERE, INTERESTED IN 1128 00:42:44,287 --> 00:42:46,423 PEDIATRIC CANCER AND THE 1129 00:42:46,423 --> 00:42:49,125 FINANCIAL HARDSHIPS PLACED ON 1130 00:42:49,125 --> 00:42:50,894 THE FAMILY, THEY SUSTAIN, YOU 1131 00:42:50,894 --> 00:42:52,495 KNOW, DUE TO GETTING TREATMENT 1132 00:42:52,495 --> 00:42:54,898 AT A YOUNG AGE. 1133 00:42:54,898 --> 00:42:55,966 >> YEAH, HAVE YOU ALSO HEARD 1134 00:42:55,966 --> 00:42:58,568 THAT FROM THE PATIENTS YOU 1135 00:42:58,568 --> 00:42:59,970 INTERVIEWED IN TERMS OF 1136 00:42:59,970 --> 00:43:01,271 FINANCIAL BURDEN AND RECEIVING 1137 00:43:01,271 --> 00:43:03,506 TREATMENT, HOW TO DEAL WITH 1138 00:43:03,506 --> 00:43:04,441 THOSE SITUATIONS? 1139 00:43:04,441 --> 00:43:05,809 >> I THINK ONE OF THE THINGS 1140 00:43:05,809 --> 00:43:09,613 THAT I DID HERE IS THERE WAS 1141 00:43:09,613 --> 00:43:11,081 NOT ENOUGH EMPHASIS ON THE 1142 00:43:11,081 --> 00:43:12,015 PSYCHOLOGICAL SIDE. 1143 00:43:12,015 --> 00:43:14,251 SO YOU GET DIAGNOSED, RIGHT, 1144 00:43:14,251 --> 00:43:17,621 IN A MEETING AND THEN AT THAT 1145 00:43:17,621 --> 00:43:19,189 SAME BREATH, YOU ARE TOLD HERE 1146 00:43:19,189 --> 00:43:21,324 IS YOUR TREATMENT PLAN OPTIONS 1147 00:43:21,324 --> 00:43:23,093 AND SOME FOLKS REPORTED THAT 1148 00:43:23,093 --> 00:43:25,595 LIKE JUST GETTING THE 1149 00:43:25,595 --> 00:43:26,529 DIAGNOSIS WAS TRAUMATIZING OR 1150 00:43:26,529 --> 00:43:27,664 VERY HARD AND NOW I AM 1151 00:43:27,664 --> 00:43:29,065 SUPPOSED TO BE LISTENING AND 1152 00:43:29,065 --> 00:43:31,034 PAYING ATTENTION TO MAKING 1153 00:43:31,034 --> 00:43:31,768 DECISIONS. 1154 00:43:31,768 --> 00:43:34,437 SO THAT IS IMPORTANT AND I 1155 00:43:34,437 --> 00:43:36,606 THOUGHT ABOUT IF THERE IS WAYS 1156 00:43:36,606 --> 00:43:38,375 TO, I DON'T KNOW, GET THE 1157 00:43:38,375 --> 00:43:40,443 DIAGNOSIS, HAVE A PAUSE, IF WE 1158 00:43:40,443 --> 00:43:41,611 COULD RECORD THE APPOINTMENT 1159 00:43:41,611 --> 00:43:43,847 SO THE PATIENT COULD REFER 1160 00:43:43,847 --> 00:43:44,281 BACK. 1161 00:43:44,281 --> 00:43:45,415 SOME CLINICS DO KIND OF WHAT 1162 00:43:45,415 --> 00:43:46,850 YOU ARE TALKING ABOUT WHERE 1163 00:43:46,850 --> 00:43:48,451 YOU CAN DEFINE THE DIFFERENT 1164 00:43:48,451 --> 00:43:49,386 ROLES AND RESPONSIBILITIES OF 1165 00:43:49,386 --> 00:43:51,921 A TEAM AND THEN AT PRY PRIOR 1166 00:43:51,921 --> 00:43:53,790 INSTITUTION, THEY ACTUALLY HAD 1167 00:43:53,790 --> 00:43:56,526 A MAPPED PATHWAY OF HERE IS 1168 00:43:56,526 --> 00:43:57,694 YOUR ANTICIPATED CARE 1169 00:43:57,694 --> 00:43:58,828 TRAJECTORY GIVEN THAT YOU HAVE 1170 00:43:58,828 --> 00:44:00,063 THIS STAGE AND THIS DIAGNOSIS 1171 00:44:00,063 --> 00:44:02,065 AND HERE ARE THE DIFFERENT 1172 00:44:02,065 --> 00:44:03,466 PEOPLE THAT FILL THESE ROLES 1173 00:44:03,466 --> 00:44:06,536 SO IT IS ALMOST LIKE A NURSE 1174 00:44:06,536 --> 00:44:07,937 NAVIGATION KIND OF PATHWAY 1175 00:44:07,937 --> 00:44:08,405 MAPPING. 1176 00:44:08,405 --> 00:44:10,273 SO I THINK THINGS LIKE THAT 1177 00:44:10,273 --> 00:44:11,541 ARE REALLY HELPFUL FOR 1178 00:44:11,541 --> 00:44:12,709 PATIENTS BECAUSE THEY KNOW -- 1179 00:44:12,709 --> 00:44:14,444 THEY CAN REFER TO THEM LATER 1180 00:44:14,444 --> 00:44:16,313 BUT THE OTHER END OF THAT 1181 00:44:16,313 --> 00:44:17,914 COIN, RIGHT, IS GETTING TOO 1182 00:44:17,914 --> 00:44:18,415 MUCH INFORMATION. 1183 00:44:18,415 --> 00:44:24,621 SO I THINK THE FINDINGS -- 1184 00:44:24,621 --> 00:44:25,789 FINDING THAT BALANCE BETWEEN 1185 00:44:25,789 --> 00:44:28,958 THINGS THAT ARE TAILORED 1186 00:44:28,958 --> 00:44:32,028 ENOUGH TO PATIENTS BUT CAN BE 1187 00:44:32,028 --> 00:44:32,829 REPRODUCED ACROSS THE SYSTEM. 1188 00:44:32,829 --> 00:44:35,598 >> YEAH, I PARTICULARLY FIND 1189 00:44:35,598 --> 00:44:40,503 THAT STRIKING, IS YOUR DATA ON 1190 00:44:40,503 --> 00:44:44,341 COMORBIDITIES LIKE IN TERMS OF 1191 00:44:44,341 --> 00:44:45,508 DEPRESSION OR ANXIETY, YOU 1192 00:44:45,508 --> 00:44:47,911 DESCRIBE TO ME TOLD YOU HAVE 1193 00:44:47,911 --> 00:44:50,547 CANCER IS FAIRLY PSYCHOLOGICAL 1194 00:44:50,547 --> 00:44:53,316 AND TRAUMATIC SO WHEN YOU LOOK 1195 00:44:53,316 --> 00:44:54,718 AT THE MULTIDISCIPLINARY TEAM 1196 00:44:54,718 --> 00:44:56,753 DO THEY HAVE PEOPLE THAT CARE 1197 00:44:56,753 --> 00:44:57,821 FOR THE PSYCHOLOGICAL IMPACT 1198 00:44:57,821 --> 00:45:00,123 OR YOU KNOW COUNSELOR OR 1199 00:45:00,123 --> 00:45:02,926 ANYBODY THAT CAN TAKE CARE OF 1200 00:45:02,926 --> 00:45:03,793 THAT ISSUE? 1201 00:45:03,793 --> 00:45:04,494 >> SOME PLACES DO. 1202 00:45:04,494 --> 00:45:07,263 I THINK THAT -- SO A LOT OF 1203 00:45:07,263 --> 00:45:09,666 OUR SAMPLE, BECAUSE THEY HAD 1204 00:45:09,666 --> 00:45:12,168 TO HAVE THE COMORBIDITY AT 1205 00:45:12,168 --> 00:45:15,138 DIAGNOSIS, THEY ALREADY HAD A 1206 00:45:15,138 --> 00:45:17,874 PRIME CARE CARE OR 1207 00:45:17,874 --> 00:45:18,908 PSYCHIATRIST MANAGING THOSE 1208 00:45:18,908 --> 00:45:21,010 AND THERE ARE SOME CLINICS 1209 00:45:21,010 --> 00:45:23,580 THAT HAVE IMPLEMENTED THE 1210 00:45:23,580 --> 00:45:25,582 PSYCHIATRY PIECE IN THE CLINIC 1211 00:45:25,582 --> 00:45:28,251 BUT THAT IS NOT STANDARD 1212 00:45:28,251 --> 00:45:28,618 PROJECTS. 1213 00:45:28,618 --> 00:45:29,419 SO THE MULTIDISCIPLINARY 1214 00:45:29,419 --> 00:45:31,321 CLINIC DOES NOT HAVE A TRUE 1215 00:45:31,321 --> 00:45:33,723 STANDARD GUIDELINE FOR HOW TO 1216 00:45:33,723 --> 00:45:35,158 IMPLEMENT IT, WHO ALL NEEDS TO 1217 00:45:35,158 --> 00:45:36,526 BE THERE AND WHAT IT LOOKS 1218 00:45:36,526 --> 00:45:38,728 LIKE SO THAT IS PART OF WHAT I 1219 00:45:38,728 --> 00:45:40,397 AM HOPING MY RESEARCH CAN 1220 00:45:40,397 --> 00:45:42,098 CREATE THAT THERE IS SOME KIND 1221 00:45:42,098 --> 00:45:43,500 OF POLICY PROPOSAL OR 1222 00:45:43,500 --> 00:45:45,902 SOMETHING THAT MAKES THIS A 1223 00:45:45,902 --> 00:45:48,405 MORE SYSTEMIC PROCESS RATHER 1224 00:45:48,405 --> 00:45:52,242 THAN, I DON'T KNOW, EVERYBODY 1225 00:45:52,242 --> 00:45:54,644 HAS THEIR OWN VIEW OF THAT AT 1226 00:45:54,644 --> 00:45:56,846 THEIR CLINIC BUT SOME TEAMS 1227 00:45:56,846 --> 00:45:58,548 HAVE IMPLEMENTED THE 1228 00:45:58,548 --> 00:46:01,418 PSYCHIATRY SIDE INTO THEIR 1229 00:46:01,418 --> 00:46:02,452 MULTIDISCIPLINARY CLINIC. 1230 00:46:02,452 --> 00:46:03,686 >> WELL, I CERTAINLY HOPE YOU 1231 00:46:03,686 --> 00:46:04,721 CONTINUE THIS RESEARCH AND 1232 00:46:04,721 --> 00:46:06,489 HELP US FIGURE OUT WHAT IS THE 1233 00:46:06,489 --> 00:46:08,091 BEST COMPOSITION OF THE 1234 00:46:08,091 --> 00:46:11,261 HEALTHCARE TEAM FOR CANCER 1235 00:46:11,261 --> 00:46:13,229 PATIENTS AND ALSO FOR 1236 00:46:13,229 --> 00:46:15,165 PATIENTS' OTHER ILLNESSES AND 1237 00:46:15,165 --> 00:46:16,633 ADDRESS THE UNIQUE CHALLENGES 1238 00:46:16,633 --> 00:46:19,836 OF RACIAL MINORITIES AND THOSE 1239 00:46:19,836 --> 00:46:21,004 ARE LOWER SOCIOECONOMIC 1240 00:46:21,004 --> 00:46:22,305 STATUS, MINORITIES AND ALSO IN 1241 00:46:22,305 --> 00:46:24,107 THE RURAL AREA BECAUSE I THINK 1242 00:46:24,107 --> 00:46:27,444 FOLKS IN THE RURAL SETTLINGS 1243 00:46:27,444 --> 00:46:28,945 WITH A PARTICULAR CHALLENGE 1244 00:46:28,945 --> 00:46:30,780 AND JUST THE PHYSICAL DISTANCE 1245 00:46:30,780 --> 00:46:32,582 GOING TO SEE DIFFERENT 1246 00:46:32,582 --> 00:46:33,283 SPECIALTIES AND DIFFERENT 1247 00:46:33,283 --> 00:46:35,852 APPOINTMENTS WHEN THE CLOSEST 1248 00:46:35,852 --> 00:46:37,887 HOSPITAL IS LIKE THREE, FOUR 1249 00:46:37,887 --> 00:46:40,790 HOURS DRIVE EACH WAY, THAT IS 1250 00:46:40,790 --> 00:46:42,759 LIKE EXTRA BURDEN ON TOP OF 1251 00:46:42,759 --> 00:46:44,027 ALL THE APPOINTMENTS AND 1252 00:46:44,027 --> 00:46:45,428 MEDICAL NEEDS THAT THEY HAVE 1253 00:46:45,428 --> 00:46:46,029 TO ATTEND TO. 1254 00:46:46,029 --> 00:46:47,363 I HOPE YOU WILL FIND A 1255 00:46:47,363 --> 00:46:48,898 SOLUTION FOR US AND THEN YOU 1256 00:46:48,898 --> 00:46:51,468 CAN COME BACK AND TELL US WHAT 1257 00:46:51,468 --> 00:46:52,402 YOU HAVE LEARNED. 1258 00:46:52,402 --> 00:46:53,703 >> WELL, I HOPE I CAN 1259 00:46:53,703 --> 00:46:56,673 ALLEVIATE SOME OF THE 1260 00:46:56,673 --> 00:46:58,308 BREAKDOWNS AT LEAST BUT YES, 1261 00:46:58,308 --> 00:47:00,710 THANK YOU SO MUCH FOR HAVING 1262 00:47:00,710 --> 00:47:02,579 ME AND FOR THE SUPPORT IN THIS 1263 00:47:02,579 --> 00:47:03,279 WORK. 1264 00:47:03,279 --> 00:47:05,815 IT WAS REALLY EXCITING AND 1265 00:47:05,815 --> 00:47:07,083 BENEFICIAL I THINK TO MOVE 1266 00:47:07,083 --> 00:47:08,852 THIS AREA OF RESEARCH FORWARD. 1267 00:47:08,852 --> 00:47:10,620 >> THANKS FOR COMING IN AGAIN, 1268 00:47:10,620 --> 00:47:11,454 WE APPRECIATE THE WORK THAT 1269 00:47:11,454 --> 00:47:13,156 YOU DO AND LOOKING FORWARD TO 1270 00:47:13,156 --> 00:47:15,124 YOUR FUTURE WORK AND IF YOU 1271 00:47:15,124 --> 00:47:17,560 DO, REACH BACK OUT TO US AND 1272 00:47:17,560 --> 00:47:19,629 WE WILL HAVE YOU IN AGAIN. 1273 00:47:19,629 --> 00:47:20,497 THANK YOU. 1274 00:47:20,497 --> 00:47:22,465 ALL RIGHT, THANKS EVERYONE, 1275 00:47:22,465 --> 00:47:22,832 TAKE CARE. 1276 00:47:22,832 --> 00:47:33,409 HAVE A GOOD REST OF YOUR WEEK.