Exploring barriers, facilitators and best practices for optimal provider-to-provider communication in hematopoietic cell transplant.

Abstract

e13550 Background: Despite its importance for care coordination, provider-to-provider communication (P2PC) across a patient’s hematopoietic cell transplant (HCT) journey is largely unstudied. P2PC is critical between hematology-oncology (hem-onc) and HCT providers and has the potential to improve equity, access, and outcomes. This study aimed to assess barriers and facilitators to optimal P2PC in HCT, establishing best practices to improve shared, coordinated care. Methods: We used qualitative case study methodology to assess two major transplant centers and their referral networks in the Northeastern U.S. and Texas. Interviews were conducted virtually with hem-onc (n = 12) and HCT (n = 18) providers, including physicians (n = 12), nurse practitioners or nurses (n = 15), and social workers (n = 3). Interviews covered P2PC, barriers to HCT, shared decision-making and care coordination. Independent coders reviewed transcripts, and findings were consolidated using thematic analysis. Coding was deductive (literature, models, expert-approved interview guide) and inductive (emerging concepts) to identify themes and relationships. We conducted additional key informant interviews with hem-onc (n = 5) and HCT (n = 7) physicians across the U.S. to provide context outside the two regions and support recommendations. Results: Themes regionally and nationally included the importance of P2PC for: (1) optimal outcomes, (2) shared care and decision-making, (3) peer education and early referral, and (4) overcoming barriers to HCT. Themes reported P2PC to be: (5) supported by tools and measures of success and (6) more challenging in areas with fewer healthcare resources and greater patient vulnerability. We observed differences between Northeastern and Texas cases, with Texas facing greater challenges to access, P2PC and shared care. Barriers and facilitators support: clearly defined responsibilities; navigators for care coordination; proactive, standardized, and documented P2PC processes; building mutual respect, transparency, and trust; knowing who to contact with direct contact information; setting clear expectations with transition plans and post-HCT instructions; and being responsive. Best practices were divided into categories by ease and resources to implement: (1) documentation, standardization and availability; (2) feedback, shared expectations and regular touchpoints; (3) staffing, financial resources and advocacy. Conclusions: This work established recommendations and best practices for P2PC in HCT to improve patient outcomes and prevent delays in care. Stronger P2PC and outreach to hem-onc practices can improve shared care, access, and outcomes, while weaker P2PC can exacerbate disparities. Hem-onc and HCT provider education, as well as advocacy for shared electronic records and reimbursement for P2PC, is needed to support practice change.