Team complexity and care coordination for cancer survivors with multiple chronic conditions: a mixed methods study

Purpose: Little is known about the perceptions and experiences of care received from healthcare teams among cancer survivors with multiple chronic conditions (MCCs).

Methods: Cancer survivors completed an online survey (N=441) of which 12 participated in an interview. Team complexity was operationalized based on team size, clinician specialties, and health system affiliation. Kilpatrick's Patient-Perceptions of Team Effectiveness (PTE) questionnaire measured team effectiveness. Constant comparative method was used to identify care coordination challenges and facilitators from interviews.

Results: Mean age at cancer diagnosis was 45 years (SD=14), 68% were 5 years from diagnosis, the most common cancer was breast (27%), and two-thirds had two or more pre-diagnosis comorbidities. Sixty percent rated both cancer and other condition(s) as taking priority. Team complexity varied from low (32%), moderate (49%), and high (20%). Eighty percent rated PTE overall as high, with variation by subscales: coordination (85%) and patient-family focus (47%). Higher team complexity was associated with lower PTE overall (p=0.049). Challenges were identified: sequential referrals with no integration across team members; no shared mental model among team; and cancer survivor having to "referee" conflicting care decisions.

Conclusion: This mixed method study found an inverse relationship between team complexity and PTE-overall, where high-complexity teams had lower team effectiveness. Participants reported issues with the problem-solving abilities of their teams and felt like their contributions were not valued by their care team.

Implications for cancer survivors: Improving team effectiveness offers one way to leverage the expertise of multiple specialties to deliver integrated, patient-centered care for the growing population of cancer survivors with MCC.