Establishing Optimal Care Coordination for Localized Bladder Cancer in the United States: A Modified Delphi Consensus Study
Gautam T. Jayram, Bernard Bright Davies-Teye, Gordon Brown, Mollie deShazo, Angela Hunter, Michael Lattanzi, Guru P. Sonpavde, Charmi PatelBackground:
Coordination of care for patients with localized bladder cancer (BC) in the United States is suboptimal, with multiple barriers to treatments. Multidisciplinary management of patients has been associated with better patient outcomes, and as novel treatments emerge, coordinated treatment decision-making is increasingly important. The aim of this study was to establish a consensus on the optimal management of localized BC and develop recommendations for care coordination and treatment selection.
Methods:
A modified Delphi process was undertaken. A steering committee identified key challenges within BC care and developed 46 consensus statements. These were disseminated across the United States to clinicians and administrators involved in BC management. The threshold for consensus was set at 75% agreement.
Results:
A total of 300 responses from the survey were accepted for analysis. Of the statements, 38 achieved very strong agreement (≥90%) and 8 attained strong agreement (≥75% but <90%). Respondents strongly supported the need to improve multidisciplinary collaboration and communication (statements 9 and 14, 95%), and promote patient-centered care (statement 39, 98%). Based on the data, a set of 10 recommendations to help optimize the care of localized BC were developed.
Conclusion:
The high level of consensus across clinicians, nurses, and practice administrators underscores broad recognition of care fragmentation in localized BC. The resulting recommendations provide a framework to enhance multidisciplinary collaboration between urologists and oncologists, improving care coordination, quality of care, and patient outcomes for those with localized BC.