Provider-to-Provider Communication in Blood and Marrow Transplant: Best Practices in Shared Patient Care to Improve Equity, Access and Outcomes

Abstract

Provider-to-provider communication (P2PC) across transitions in patient care has gone largely unstudied. No established guidelines, models, or scales measure P2PC directly. P2PC is especially important between hematology-oncology providers and blood and marrow transplant (BMT) physicians for patients with blood cancers like leukemia. When the burden of P2PC falls on the patient, it can cost time, money, and lives. While access to BMT is limited by factors beyond physician control, less than half of patients who may need BMT receive the procedure. Barriers exist across race/ethnicity, geography, and socioeconomic status. However, strong P2PC and improved care coordination may alleviate barriers to care. In Study 1, I conducted a scoping review and identified only 10 studies measuring P2PC in BMT, with only one directly aiming to assess P2PC. Studies generally supported P2PC as a tactic to overcome barriers to BMT. In Study 2, I combined national datasets to explore quantitative associations between social vulnerability, hematology-oncology provider and BMT physician density, and the unmet need of allogeneic BMT across all U.S. counties (n=3,141). Physician density and social vulnerability were significant predictors of unmet need. I identified Texas, North Carolina, Florida, Nevada, and Georgia as the top states most at-risk for allogeneic BMT access challenges. In Study 3, I used a qualitative case study approach in the Northeastern U.S. (n=15), South Central U.S. (n=15), and key informant interviews across the U.S. (n=12) to identify six themes highlighting P2PC’s ability to facilitate shared care and decision-making, peer education and referral, overcome barriers to BMT, and improve outcomes. I found that P2PC is more challenging when patients and healthcare systems have fewer resources, and that tools and measures can help optimize P2PC and care coordination. Additionally, I identified barriers and facilitators to P2PC in BMT across roles and resources, processes, and relationship building, proposing best practices. Results solidify the need for a P2PC measure, laying the groundwork for its development. Research assessed emerging and existing models that may apply to P2PC for future theory development. Work can guide education, future research, and interventions in BMT and inform expansion to other fields of medicine.