Integrating Patient Preferences in Oncology Care Models

The Emerging Importance of Patient Preferences in Oncology

Understanding Patient-Centered Care in Oncology

Patient-centered care in oncology means respecting and responding to individual patients' preferences, needs, and values throughout their cancer care journey. It prioritizes quality of life alongside clinical outcomes, ensuring treatment plans align with what matters most to each patient.

Challenges in Traditional Oncology Care

Conventional oncology care often emphasizes standardized treatment guidelines and clinical outcomes, sometimes overlooking the diverse preferences and unique circumstances of patients. Communication gaps, limited consultation time, and insufficient incorporation of patient values can make care feel impersonal and rigid.

The Role of Shared Decision-Making and Integrating Patient Preferences

Shared decision-making (SDM) addresses these challenges by actively involving patients in treatment decisions. SDM integrates clinical evidence, provider expertise, and patient goals—including age, quality of life, cultural, and financial considerations. Models like the Integrated Oncological Decision-making Model (IODM) have been developed to facilitate this process, moving care from disease-centered to truly patient-centered. This approach not only improves patient satisfaction but can also lead to treatment plans tailored to individual needs without compromising outcomes.

The Oncology Care Model: Structuring Value-Based, Patient-Centered Oncology

What is the Oncology Care Model (OCM)?

The Oncology Care Model (OCM) is a five-year initiative developed by the Centers for Medicare & Medicaid Services (CMS) aimed at enhancing cancer care quality while controlling costs in the U.S. It provides a value-based payment system focused on episodes of chemotherapy treatment, covering over 150,000 Medicare beneficiaries across 34 states. OCM engages a broad spectrum of oncology practices—from solo private offices to large academic centers—encouraging them to implement patient-centered cancer care decisions and coordinated care strategies.

Payment Incentives and Care Coordination Features

OCM employs a Two-part OCM payment system: a predictable monthly Enhanced Oncology Services (MEOS) payment—$160 per beneficiary—to support care management activities, and performance-based payments linked to OCM quality improvement incentives and cost savings. This design incentivizes practices to improve coordination, adhere to clinical guidelines in oncology, and lower unnecessary spending, particularly by optimizing the use of non-chemotherapy drugs.

Implementation of Enhanced Oncology Services Like 24/7 Clinician Access

Participating practices must provide enhanced services including 24/7 patient access to address patient needs outside typical office hours, comprehensive personalized cancer care plans tailored to individual patients, and systematic use of electronic health records to facilitate communication in oncology care and documentation. These features promote timely decision-making and support advanced care planning.

Impact on Patient Engagement and Workflow Redesigns

To meet OCM requirements, practices undergo workflow redesigns emphasizing shared decision-making in healthcare, patient navigation, and integration of multidisciplinary approach in cancer care. This approach improves patient engagement, ensuring that care reflects patient preferences in treatment and values while fostering trust and satisfaction. Enhanced communication tools help patients understand oncology treatment options and next steps, fostering a more collaborative care experience.

Role of Shared Decision-Making Within OCM

Shared decision-making in oncology lies at the core of OCM, driving personalized treatment plans that balance clinical evidence with patient preferences such as quality of life in cancer treatment, treatment burden, and financial concerns. By mandating explicit inclusion of patient goals and preferences in care planning, OCM supports a transition from disease-centered to patient-centered healthcare in oncology, promoting more meaningful conversations between clinicians and patients.

Aspect	Description	Impact
Definition & Goals	CMS model to improve quality and reduce costs via episode payments	Value-based care shift; broad provider participation
Payment Incentives	Monthly payments + performance bonuses	Encourages care coordination and guideline adherence
Enhanced Services	24/7 clinician access, care plans, EHR use	Improved responsiveness and documentation
Patient Engagement	Workflow changes, patient navigation	Increased shared decision-making in healthcare and treatment satisfaction
Shared Decision-Making Role	Emphasizes incorporating patient-centred decision-making and patient preferences	Personalized, patient-centered care plans

Enhancing Oncology Model: Building Upon OCM for Greater Patient-Centeredness

What is the Enhancing Oncology Model (EOM)?

The Enhancing Oncology Model (EOM) is a voluntary, nationwide initiative launched in July 2023 by the Centers for Medicare & Medicaid Services (CMS) to improve oncology care for Medicare beneficiaries. It focuses on seven high-risk cancer types: breast, lung, leukemia, colorectal, lymphoma, multiple myeloma, and prostate cancer. The EOM is designed to promote value-based care in cancer treatment by aligning financial incentives with quality, coordination, and patient-centeredness in cancer treatment.

Expansion of Patient-Centered Features Including Electronic Patient Reported Outcomes (ePROs)

Building on the Oncology Care Model (OCM), the EOM incorporates enhanced patient-centered components such as electronic Patient Reported Outcomes (ePROs), which allow patients to regularly report symptoms and quality of life in cancer treatment measures digitally. This continuous feedback helps clinicians better tailor treatment plans and promptly address patient concerns, improving the overall care experience.

Focus on Social Needs Screening and Health Equity

EOM emphasizes screening for health-related social needs (HRSNs), addressing social determinants that can affect cancer outcomes such as transportation, housing, and financial challenges. By broadening support beyond clinical care, the model aims to reduce disparities and advance health equity for underserved populations, aligning with EOM health equity focus.

Performance Metrics and Financial Incentives

The program uses a two-part payment system: Monthly Enhanced Oncology Services (MEOS) payments support innovative care services, including 24/7 access and patient navigation, while performance-based payments reward practices for improving quality and managing total episode spending. Financial risk is shared with providers to encourage efficiency without compromising care.

Coordination Among Providers, Payers, and Stakeholders to Improve Cancer Care

EOM fosters collaboration between physician group practices, commercial payers, and CMS. This multi-stakeholder engagement facilitates sharing of best practices and aligns incentives to deliver coordinated, high-quality oncology care. Currently, the model involves over 34 practices, 3,000 practitioners across more than 500 sites, and engages commercial payers in addition to Medicare.

Together, these advancements position the Enhancing Oncology Model as a forward-looking framework that builds on the foundation of Oncology Care Model (OCM) to deliver more personalized cancer care, equitable, and sustainable cancer care across the U.S.

Integrating Patient Preferences in Oncology: The Foundations of Person-Centered Care

What is person-centered care for cancer patients?

patient-centred care in precision oncology focuses on respecting and responding to each patient's unique preferences, needs, and values. It ensures that patient values guide all clinical decisions, promoting a holistic treatment approach.

How does shared decision-making (SDM) and multidisciplinary teamwork enhance care?

shared decision making quality measures and reimbursement involves clinicians and patients collaborating to choose treatments based on medical evidence and patient preferences. Multidisciplinary team meetings in cancer management including oncologists, nurses, and support specialists, enable comprehensive consideration of medical options and patient goals, fostering personalized care plans.

Which individual patient factors are crucial in decision-making?

Age, quality of life in cancer treatment, frailty, cultural and spiritual values, and treatment burden play important roles. Older patients especially require assessments beyond clinical guidelines in oncology to align treatment with their personal priorities and health status.

What models and tools support integrating patient preferences?

The Integrated Oncological Decision-making Model facilitates SDM by incorporating medical treatments, patient goals, and overall health. The ASK Patient–Clinician Communication Model empowers patients to ask critical questions about options, benefits, harms, and consequences of no treatment.

What challenges exist in including patient preferences, and how are they overcome?

Barriers include limited consultation time, literacy gaps, sociocultural factors, and inconsistent documentation of preferences. Strategies to address these challenges include using incorporating patient preferences into cancer care, electronic health records, assigning roles for preference elicitation, and promoting effective communication skills among providers.

patient-centred care in precision oncology is a dynamic approach, integrating patient values and clinical expertise. By embracing shared decision making quality measures and reimbursement and Multidisciplinary team meetings in cancer management, oncology teams can deliver personalized, compassionate care that improves quality of life in cancer treatment and treatment adherence.

The Five Pillars and Multidisciplinary Coordination in Personalized Cancer Care

What are the five pillars of cancer treatment?

Cancer treatment rests on five foundational pillars: surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Each pillar targets cancer differently, and significant advancements in these areas have contributed to improved survival and quality of life in cancer treatment for patients.

Surgery involves physically removing tumors, often complemented by radiotherapy to target residual cancer cells. Chemotherapy utilizes systemic drugs to kill rapidly dividing cells, while targeted therapies focus on specific molecular markers unique to cancer cells. Immunotherapy harnesses the patient's immune system to recognize and combat cancer. These multidisciplinary approach in cancer care provide the basis for comprehensive cancer care.

Why are multidisciplinary teams important in cancer care planning?

Multidisciplinary teams (MDTs) bring together specialists such as surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, nurses, and supportive care experts. This collaboration ensures all aspects of care—from diagnosis to treatment planning and supportive services—are coordinated effectively.

Effective models of cancer care integrate four critical elements: clearly defining the patient population served, coordinating care across providers, building robust provider networks, and implementing quality measurement with performance improvement metrics. MDTs serve as the platform where these quality and coordination elements converge to align treatment decisions with the best available evidence and patient goals and health status.

How are patient preferences integrated within multidisciplinary decision-making?

Integrating patient preferences in treatment within MDT discussions is vital for personalized, patient-centred decision-making. Preferences can include treatment goals, quality of life considerations, cultural values, social support, and concerns about treatment burden like financial toxicity concerns in cancer treatment.

Tools such as the ASK (AskShareKnow) communication model empower patients to engage by querying their options, benefits, and consequences. Dedicated roles in MDTs, like nurse navigators, help elicit and document preferences to inform treatment planning. However, challenges include time constraints, literacy barriers, and inconsistent documentation in busy clinical settings.

What are the benefits and challenges of collaborative care approaches in oncology?

Collaborative care models improve quality of life and adherence to treatment by facilitating communication, care coordination, and shared decision-making. Programs like the Oncology Care Model (OCM) and Enhancing Oncology Model (EOM) in the U.S. provide structural support including 24/7 access, patient navigation, and integration of behavioral health services.

However, challenges include balancing clinical guidelines in oncology with individualized care, logistical barriers during MDT meetings, and addressing psychosocial needs amid busy workflows. Effective collaboration reduces fragmentation and supports comprehensive care.

What role does palliative and supportive care play in oncology?

Palliative and supportive care in oncology are essential components that focus on symptom management, psychological support, and improving quality of life through the cancer continuum. Early integration of palliative care has shown to reduce hospitalizations, emergency visits, and depression while enhancing patient satisfaction.

Models embedding palliative care services into standard oncology treatment facilitate communication about prognosis and preferences, alleviate suffering, and provide holistic support. Renaming palliative care as "supportive care" in some settings improves patient acceptance and referral rates.

Aspect	Summary	Impact/Challenge
Five Pillars	Surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy	Diverse modalities tailored to patients
Multidisciplinary Teams (MDTs)	Multi-specialty collaboration ensures comprehensive planning and quality measures	Time constraints, coordination challenges
Patient Preferences	Includes treatment goals, quality of life, and financial concerns	Barriers include communication and documentation gaps
Collaborative Care Models	Oncology Care Model, behavioral health integration, patient navigation	Logistics, balancing guidelines with personalized care
Palliative and Supportive Care	Early symptom management, psychological support	Enhances quality of life, sometimes stigmatized

This integrated approach fosters personalized, patient-centered healthcare in oncology that addresses both clinical and personal dimensions of treatment.

Benefits of Patient-Centered Oncology Care on Quality, Trust, and Outcomes

What are the benefits of patient-centered care in oncology?

Patient-centered care (PCC) significantly enhances the quality of oncology care by improving communication between patients and providers. This leads to increased trust in doctors and greater patient satisfaction. When patients feel heard and involved through shared decision-making (SDM), their treatment plans better align with their values and preferences, which is particularly important in the complex landscape of cancer treatment.

How does patient-centered communication address emotional needs and uncertainty?

PCC helps address emotional concerns and uncertainty that cancer patients often face. By providing clear explanations, allowing time for questions, and supporting patients emotionally, care providers foster a supportive environment. This reduces anxiety and builds trust, encouraging patients to engage more actively in their care process.

What is the impact on treatment adherence and psychological well-being?

Engagement through PCC and shared decision-making in healthcare improves treatment adherence as patients better understand their options and feel confident in their choices. While PCC may not always directly increase self-efficacy, it fosters psychological well-being by validating patients' feelings and managing emotional stress linked to cancer diagnosis and treatment.

Why is discussing financial toxicity and social determinants of health important?

Financial toxicity, including the burden of out-of-pocket costs, strongly affects patient preferences but is often under-discussed. Addressing financial and social factors within patient-centered cancer care decisions helps tailor treatment decisions, reducing stress and potential barriers to adherence.

How do technological tools support patient-centered communication?

Electronic health records and patient decision aids can enhance communication but must be effectively integrated into clinical workflows. Currently, these tools do not automatically improve outcomes unless coupled with genuine provider-patient engagement focused on patient preferences in treatment and concerns.

Aspect	Benefit	Description
Perceived Quality of Care	Enhanced patient satisfaction	Patients feel respected and valued
Trust in Doctors	Increased trust	Open, clear communication builds confidence
Emotional Support	Reduced anxiety and uncertainty	Addresses psychological needs through dialogue
Treatment Adherence	Improved compliance and outcomes	Patients better understand and follow treatment
Financial and Social Factors	Tailored care plans	Recognizes financial burden and social determinants
Technology Integration	Supports communication	Requires thoughtful use alongside human interaction

Contextualizing Oncology Care Models Within the U.S. Healthcare System

What are the main models of healthcare in the United States?

The U.S. healthcare system is a complex blend of multiple models rather than a single unified system. It incorporates the Beveridge model, exemplified by government-funded programs like the Veterans Affairs system, where care is financed through taxation. The Bismarck model influences employer-based insurance plans, utilizing payroll deductions to fund health benefits. Medicare represents aspects of the national health insurance model, providing government-sponsored coverage primarily for seniors. Finally, the out-of-pocket model persists where individuals directly pay for services, often in areas with limited insurance access.

How do these models influence oncology care delivery?

Oncology care in the U.S. operates within this intricate framework, impacting service delivery, access, and patient experience. For example, Medicare's Oncology Care Model (OCM), and its successor, the Enhancing Oncology Model (EOM), align with national health insurance principles by incentivizing quality and coordinated cancer care for Medicare beneficiaries. Employer-based plans often negotiate care within network parameters influencing treatment accessibility, while out-of-pocket expenses remain a significant concern for patients, affecting care decisions and adherence.

What challenges and opportunities arise from this integration?

The multiplicity of healthcare payment and delivery models poses coordination challenges such as disparities in access, especially in rural and underserved communities. Programs like OCM and EOM aim to bridge gaps by promoting patient-centered approaches, care coordination, and shared decision-making. They encourage standardized yet personalized oncology practices addressing treatment burden, financial toxicity, and patient preferences.

How are OCM and EOM reshaping oncology care?

Started in 2016, the OCM introduced value-based oncology care with enhanced payments supporting care coordination and quality metrics. It improved multidisciplinary communication, patient navigation, and reduced some treatment costs though with variable impact on overall savings. Building upon this, the EOM launched in 2023 incorporates lessons learned by emphasizing health equity, social needs screening, and electronic patient-reported outcomes, aiming for broader quality improvements and cost effectiveness.

What future directions are critical for oncology care within the U.S. system?

Addressing fragmentation requires system-level improvements including policy reforms focusing on training, reimbursement incentives, and integration of electronic health tools. Enhancing patient-centered care demands culturally sensitive communication strategies and expanded access to clinical trials, especially for marginalized populations. Continued evaluation and innovation in payment models like EOM will be vital to achieving equitable, efficient, and personalized oncology care nationwide.

Toward a Future of Personalized, Patient-Centered Oncology Care

Embracing Patient Preferences in Oncology

Recent advancements stress centering patient preferences, such as treatment goals, quality of life, and financial concerns, into oncology decision-making. Tools like shared decision-making models and communication frameworks (e.g., ASK) empower meaningful dialogues between patients and clinicians.

Value-Based Care Models Driving Change

Programs like the Oncology Care Model (OCM) and Enhancing Oncology Model (EOM) promote coordinated, high-quality care while incentivizing cost reductions. They support patient navigation, 24/7 access, and comprehensive care plans tailored to individual needs, marking a shift toward value-driven, patient-centered oncology.

Addressing Challenges and Enhancing Coordination

Barriers remain including communication gaps, time constraints, and inconsistent documentation of patient preferences. Multidisciplinary collaboration and integrating electronic health records help improve care coordination and adherence to guidelines.

Committing to Equity and Sustained Engagement

Equity initiatives in these models focus on underserved populations, ensuring all patients have access to personalized care. Sustained patient involvement, supported by technology and policy reforms, is essential for advancing quality and trust in cancer care delivery.