A multidisciplinary model of care for childhood cancer survivors with complex medical needs

Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses
Claire A CarlsonJill P Ginsberg

Abstract

Long-term survival for children with cancer is often achieved at a considerable cost in terms of medical and psychological sequelae. Although many survivors are well and require only routine follow-up and surveillance, a cohort of survivors require comprehensive management of complex, chronic medical issues by multiple subspecialists. For these survivors, care delivered within the context of an annual visit to a traditional hospital-based late effects clinic or by a primary care physician in the community is often not adequate. A specialized clinic was implemented at The Children's Hospital of Philadelphia that crosses disciplines and provides same-day, same-clinic access to oncology/survivorship, endocrinology, pulmonology, cardiology, nutrition, and psychology. This multidisciplinary approach supports clinical efficiency and fosters seamless patient-centered care both for patients with identified late effects and for those with the highest risk for problems because of intense treatment exposures. The model is described with a focus on clinic structure/process, clinical outcomes, and benefits to survivor, health care provider, and institution. The diverse roles for nursing within this model are highlighted.

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Citations

Oct 4, 2011·Journal of Clinical Psychology in Medical Settings·Lisa A SchwartzJill P Ginsberg
Aug 4, 2011·Journal of Multidisciplinary Healthcare·Mary Ann Cantrell, Kathy Ruble
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