of coordination using a variety of strategies for individuals with congestive heart failure, diabetes, severe mental illness, a recent stroke, or depression, although the reviewers noted that it was not possible to identify the key component(s) of the care coordination interventions that were responsible for their effectiveness. Significantly, the review found that when systematic reviews addressed “other clinical areas such as rheumatoid arthritis, pain management, asthma, and cancer [emphasis added], there is insufficient evidence to draw firm conclusions” (McDonald et al., 2007:7). Nonetheless, until research provides better direction with respect to coordination within the context of cancer care, clinicians caring for these patients and their families will need to implement mechanisms for coordinating care based on the findings of care coordination studies for other diseases and for populations with varied conditions and on the limited studies addressing care coordination in cancer.

Cancer care typically requires multiple professional caregivers to provide accurate diagnosis and staging, surgical treatment, adjuvant or definitive chemotherapy and/or radiotherapy, and ongoing management of comorbid problems, as well as psychosocial support. The multiple handoffs involved in typical cancer care generate opportunities for confusion, redundancy, breakdowns in communication, and medical errors. Patients and families, with variable help from their clinicians, must often take the initiative to ensure that relevant information is shared across providers and that care is coordinated. The psychosocial problems described earlier, as well as the complexities of oncology care, can make it difficult if not impossible for patients and caregivers to carry out this role. This difficulty is exacerbated by the fact that care coordination as a psychosocial intervention must fulfill a dual function: coordination of psychosocial health services with biomedical services, and coordination of biomedical care provided by multiple clinicians.

Consistent with the findings of the AHRQ evidence review, both types of care coordination are likely to be achievable in various ways, including the activities described in the preceding section that are effective in linking patients to needed psychosocial health services, such as case management and collocated, clinically integrated services. A study of the efforts of hospitals and cancer centers to coordinate the care of patients with breast cancer also found the use of regularly scheduled multidisciplinary meetings and patient support personnel, such as patient educators and care navigators (Bickell and Young, 2001). In a randomized controlled trial of the integration of medical care with mental health services, same-site location, common charting, enhanced channels of communication (including joint meetings and e-mail), and in-person contact were found to facilitate the development of common goals and the sharing of information between medical and mental health providers (Druss et al., 2001). Other coordination

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