Building an Onco-Hospitalist: Identifying Hospitalist Perceptions of Care Gaps for Inpatient Oncology Patients

Abstract

Background: Hospitalized patients with cancer face complex medical challenges, including longer stays, higher readmission rates, and increased in-hospital mortality. To address these needs, many institutions have adopted co-management models involving oncology-focused hospitalists (“onco-hospitalists”) working alongside oncology specialists. While this model offers benefits, differences in training between hospitalists and oncologists can affect medical management, and divergent perspectives on prognosis and goals of care may stall interprofessional collaboration. Methods: At our institution, hospitalists managing a dedicated inpatient oncology service reported increased stress and communication challenges. In response, a needs assessment evaluated hospitalist perceptions of these domains to inform targeted quality improvement efforts in the inpatient care of advanced cancer patients. Through structured discussions with oncologists, nurses, and palliative care providers, 3 key domains were identified: (1) Medical Management, (2) Patient Communication, and (3) Interprofessional Collaboration. Surveys were distributed to all hospitalists on the oncology service pre-intervention (n = 25). Results: Among all respondents (n = 19), confidence was high in pain and symptom management but lower in managing therapy side effects and basic oncologic pharmacology. Confidence in communication was high in breaking bad news and general goals-of-care discussions but lower for discussing the radiation oncology process or when asked about prognosis by the patient or family. Strong collaboration was noted with nursing, case management, pharmacy, and palliative care, but weaker with oncology and radiation oncology consultants. Conclusion: These results provide a clear framework for our institution in developing a strong novel onco-hospitalist program with goals to close knowledge gaps and enhance collaboration for improved patient care.