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General Discussions

Team Approach to Advanced Melanoma Treatment at MSKCC

By Michael A. Postow, MD and Claire Crowley, RN


Michael A. Postow, MD:
One of the important issues in taking care of patients with metastatic melanoma and really many complex cancers — patients getting immune therapy or even other standard treatments — is ensuring everyone on our team in all of our various roles knows what we’re doing and how to work best together. And really, all of our multidisciplinary team members need to function well as a team. So, Claire, if you don’t mind, tell us a little bit about the different components of our team and what everyone’s role is in helping to manage patients in general.

Claire Crowley, RN: Well, we have an office assistant who manages the phone calls, scheduling, and we also have an assistant in clinic who helps us more in clinic. As we said, I think it’s important that that office assistant, who’s receiving the phone calls firsthand, has an understanding of some medical aspect of the patients even though they’re not a clinician necessarily. Because, that allows them to triage what’s emergent and what’s not, have a better understanding of the patient and their acuity, and be able to relay that information to myself or the physician.

Michael A. Postow, MD: And I agree with you completely. I think it’s really critical that whoever is answering the phone needs to be very clear about making patients feel comfortable about talking about sensitive topics such as diarrhea, or a rash, or other things that they may not know. Some of these patients calling in, they may know the doctor or the nurse, but that the person that they’re calling on the phone that works in a lot of the offices may be someone that they don’t necessarily always interact with. I think creating that sense of comfort from the office staff is really critical, and receiving the information about patient side effects and issues.

One of the other points that you brought up, which I think is a really important one, is that many times this person is not a clinician themselves. And so, we have weekly meetings where we all get together as a team. So, we have our nurse, our doctor, and our office assistant that get together and have a weekly meeting where they run down our list of all patients and what’s going on. Can you talk a little bit more about what happens in these weekly meetings, what some of the goals of those kinds of meetings can be, and how that really can enhance team communication and all of our understanding of the roles that we play in this multidisciplinary group?

Claire Crowley, RN: Well, I think the meetings are really important. We’re all very busy and the clinic can be hectic. It gives us a period of time to all get together, regroup, run through our clinic from the day before, talk about who’s coming, and also bring in any outside issues. And I think by doing so, our office assistant is able to have a better understanding of the patients, gain insight on who might be calling, who’s critical, and what the symptoms are that immunotherapy patients are experiencing. Then, we all have a better understanding of what’s to come and what our plan is for the coming week.

Michael A. Postow, MD: Yes, I agree. I think it’s really important. If it’s a half hour or if it’s an hour, going quickly through everything that’s been going on, it really actually, I think, increases team efficiency because then everyone functions more independently and there’s less back and forth among our different group members about what’s going on. But, through use of email, talking, I think it’s really critical to have that kind of communication that we all have. I think that’s important, and I think other practices will have their own strategies of how they handle these kinds of situations. But, I would encourage these once-a-week meetings, at least, where patients are discussed. Education is provided to all members of the team, so we’re all learning together.

Claire Crowley, RN: And I think it’s a good time for collaboration. We can talk about different approaches, what we think is working, and what we think isn’t for some patients. It’s a good regrouping.

Michael A. Postow, MD: Absolutely, and they will all bring their own part of the story of the patient’s experience to those conversations. Sometimes there are things I’ve never heard about that our office assistant may have been hearing about on the phone, for example. That’s a really good time that we can learn from each other about different angles of the patient experience and what they’re going through because it’s much more than we can really obtain just in the clinic visit itself, which is often very quick sometimes.

Claire Crowley, RN: Right. I’m a registered nurse in melanoma at Memorial Sloan Kettering. I work with my physician as well as a multiple disciplinary team in the assessment and treatment of our patients. We collaborate on a daily basis on treatment regimens, symptom management, goals of care, as well as psychosocial supportive care. I see and assess patients in clinic as well as follow up with them in triage phone calls. We also work together with other disciplines, such as social work, case management, as well as our research team, in the care of our population of patients.

On a typical day in clinic, we see a number of patients, sometimes up to 25. The patients will come in. Sometimes it’s a new visit, sometimes they’re just receiving their treatment. I will go in and assess the patient. Most of the time, I know these patients well. I’m familiar with them. We talk about any side effects they’ve been experiencing, any concerns they have. I go back and collaborate with my physician. We talk about any issues that may have arose. Sometimes, there’s nothing to discuss and the patient is tolerating everything fine. We check their labs. Depending on their lab values, they’ll be set for treatment or we’ll have to reassess whether treatment can be held at this time due to any abnormalities.

Transcript Edited for Clarity
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