How do you take an assortment of individual medical professionals from various disciplines and turn them into a well-oiled lung cancer screening machine?
By tapping into the “power of diversity,” says Geoffrey Rubin, MD, the George B. Geller Distinguished Professor of Radiology and Bioengineering at Duke University and moderator of a session entitled “Developing an Effective Lung Cancer Screening Team” at the upcoming annual meeting of the American College of Radiology in Washington, D.C., in May.
Rubin spoke with Health Imaging about the ideal lung cancer screening team, the challenges of building and managing a multidisciplinary team, and the overall benefits of effective screening programs on the radiology profession.
Health Imaging: How do you define success—What constitutes an effective lung cancer screening program?
Geoffrey Rubin, MD: Ideally it's one where eligible patients are informed about lung cancer screening, the benefits that it potentially offers and are subsequently provided, and the opportunity to decide whether screening is right for them. That's the first step.
Then, once it's been determined that they do want to proceed, the CT scan is performed and the results provided to them are contextualized effectively so that they truly understand the meaning of those results. If anything is discovered, they should have a proper hand-off to an appropriate physician to manage whatever is seen and to help oversee management downstream.
All of this should occur within the context of an environment where information is shared and communicated across all the stakeholders, so that everybody is aware of a patient's status at any point in time. And that it's not just a matter of person-to-person communication, but is supported through an effective infrastructure of information technology that helps to facilitate the overall management of the individual patient screening process as well as the screening program as a whole.
Your presentation is focused on the idea that there is power in diversity: How can healthcare facilities harness that power to create a multidisciplinary screening team?
What we know from behavioral economics and social psychology is that decisions are more effectively made when teams are diverse, and that reaching out and engaging people with different perspectives almost always results in a better outcome.
Unlike most imaging services that are entirely contained within the radiology department, a lung cancer screening program requires effective collaboration with a spectrum of practitioners outside the department as well as within.
The CMS mandate for reimbursement necessitates that there is counseling related to cigarette-smoking cessation and that there is shared decision-making to assure that the patient is well-informed about the implications of entering into screening, and oftentimes it's necessary to follow patients over time.
For these reasons, it really is critical to have strong linkages into primary care for the pre-screening elements, and into pulmonary medicine or internal medicine for the post-screening elements, particularly if there's something positive that is found.
How do you balance what could potentially be differing perspectives and possibly even competing priorities among team members from varying disciplines?
The likelihood of discordance among team members is diminished when the focus is principally upon what is best for the patient. In some circumstances it might be important to remind team members that the whole purpose of the program is to provide a patient-centered and patient-focused solution. That can really help to inform when there are competing views on a specific problem.
It may not be that every issue receives 100 percent agreement, but effective teams, when they come together, develop an understanding of how they're going to work together as a team. And one of the most important things that teams do at the very outset is discuss how they will make decisions when there is discordance. As long as there are guidelines and members of the team understand the process, what they've agreed to, and how they're going to operate, then there shouldn't be too much conflict.
As leaders of the lung cancer screening team, what are the challenges for radiologists in terms of managing a diverse team of medical professionals in a wide range of specialties?
It may be that radiologists starting this process don't have existing relationships with all of the key team members. So for a successful program, the radiologist leader is going to have to be committed to reaching out and finding partners, ideally partners who are passionate and committed to the team's charge. Hopefully, they are present; if not, it can be a struggle.
You also want to be sure that you have a venue for people to discuss their concerns and their ideas, so the first step is making sure that there are regular meetings among the team members to review the performance of the team and the performance of the program, and to allow concerns and ideas to come forward.
What aspects of the collaborative nature and diversity of lung cancer screening teams can providers use to influence the overall quality of their radiology services?
Lung cancer screening programs are a marvelous example of the realization of the Imaging 3.0 initiative. Being patient-focused, being focused on measuring quality and collecting outcomes data, reaching out and engaging and developing strong relationships with other healthcare providers—all of those are critical linkages in the Imaging 3.0 chain.
What we see in these programs is the kind of engagement that radiologists should seek even more broadly in their practices, because this is the kind of functionality that is going to assure the success of the specialty moving forward.
Author's note: This conversation was edited for length and clarity.