title: Interdisciplinary counseling service for renal malignancies: a patient-centered approach to raise guideline adherence.
abstract: OBJECTIVE
  Tumor boards have become an integral part of high-quality cancer care, but in general, patients are not directly involved. To overcome this weakness, we established an interdisciplinary counseling service for renal malignancies where 4 specialists talked to the patient at once. We evaluated this approach from the patients' and physicians' perspective.
  
  
  METHODS
  For 3 months, we assessed organizational and clinical data. Within a standardized telephone interview lasting for 14 ± 8 minutes, we explored the patients' view 1 week after counseling. A focus group contributed the physicians' perspective. Costs and revenues were calculated from the hospital's perspective.
  
  
  RESULTS
  We included 52 consecutive patients aged 62 ± 10 years. Patients' initiative for a "second opinion" triggered 37% of all appointments. Patients had localized (52%) and systemic (48%) disease presenting with primary diagnosis (48%), relapse (27%), or under continuous therapy (25%). The treatment strategy was changed significantly in 16 of 30 (53%) patients reporting a specific external opinion. The most frequent changes in recommendation were nephron-sparing surgery instead of radical nephrectomy in 8 cases and divergent judgments on restaging causing changes in systemic treatment in 6 cases. We successfully interviewed 43 of 52 patients. Overall, patients rated the consultation as very positive and only 1 patient (2%) was dissatisfied. Patients rated the quality of interpersonal interaction as very positive and said they would recommend the consultation service to others. Disease state was not associated with ratings. Physicians expressed a very positive opinion, highlighting the patients' benefit and very constructive case discussions. Nevertheless, they report remarkable efforts concerning time investment and effective coordination of medical experts. We estimated a deficit of 39 Euro per patient given the German health care system. There might be relevant secondary positive economic effects for the hospital such as recommendations from one patient to another leading to acquisition of additional patients.
  
  
  CONCLUSIONS
  Patient involvement in multidisciplinary tumor boards is feasible and well regarded by patients and physicians likewise. By stimulating interdisciplinary collaboration, the interdisciplinary counseling service improves patient satisfaction and clinical decision making. The interdisciplinary counseling service corrected half of the external treatment plans for better guideline adherence. These positive effects come at the price of higher resource utilization. (www.germanctr.de, number DRKS00003279).
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: johannes.huber@uniklinikum-dresden.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Huber
authors.affiliation: Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany. Electronic address: andreas.ihrig@med.uni-heidelberg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ihrig
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Winkler
authors.affiliation: Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Brechtel
authors.affiliation: Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
authors.affiliation: Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Frank
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Grüllich
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hallscheidt
authors.affiliation: Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
mesh_terms: D002292:Carcinoma, Renal Cell / Q000523:psychology* / Q000628:therapy*; D003376:Counseling / Q000379:methods* / Q000592:standards; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007680:Kidney Neoplasms / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires
keywords: Decision making; Guideline adherence; Patient involvement; Renal cell carcinoma