Trial Outcomes & Findings for Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology (NCT NCT02123797)

NCT ID: NCT02123797

Last Updated: 2020-07-02

Results Overview

Number of patients with a test that provides tissue confirmation of the stage-defining lesion. Tests include a biopsy of any identified suspicious metastatic lesion or the primary lesion in the absence of any other suspicious lesion. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

• Recruitment status: COMPLETED
• Target enrollment: 781 participants
• Primary outcome timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months
• Results posted on: 2020-07-02

Participant Flow

The recruitment process included a patient population of those receiving care and/or treatment for their lung cancer from physicians and clinics within the Baptist Cancer Center network, including sites in the Memphis metropolitan area, Oxford, Mississippi, and Jonesboro, Arkansas. Dates of recruitment were from October 2014 through May 2016.

Patient eligibility criteria: diagnosis of lung cancer within 6 weeks of screening date, an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, no previous lung cancer diagnosis, and no diagnosis of other cancers within the past 5 years. Caregivers and clinical care providers (doctors/nurses) of eligible patients also gave consent.

Participant milestones

Measure	Multidisciplinary Clinic Patients For the multidisciplinary arm, patients and their informal caregivers are seen by multiple specialists at a single appointment time.	Serial Care Patients For the serial care arm, matched serial care control patients receive the current system of linear, sequential, referral-based care delivery.	Multidisciplinary Caregivers Consenting caregivers of consented multidisciplinary clinic patients (patients seen by multiple specialists at a single appointment time).	Serial Care Caregivers Consenting caregivers of consented serial care patients (patients who receive the current system of linear, sequential, referral-based care delivery).	Clinical Providers Clinical providers who referred at least 5 patients to the multidisciplinary program and consented to the study.
Baseline Intervention STARTED	178	348	100	144	11
Baseline Intervention COMPLETED	156	306	100	144	11
Baseline Intervention NOT COMPLETED	22	42	0	0	0
3-month Follow up (Cumulative Counts) STARTED	156	306	100	144	11
3-month Follow up (Cumulative Counts) COMPLETED	99	189	50	62	8
3-month Follow up (Cumulative Counts) NOT COMPLETED	57	117	50	82	3
6-month Follow up (Cumulative Counts) STARTED	156	306	100	144	8
6-month Follow up (Cumulative Counts) COMPLETED	101	178	34	31	5
6-month Follow up (Cumulative Counts) NOT COMPLETED	55	128	66	113	3

Reasons for withdrawal

Measure	Multidisciplinary Clinic Patients For the multidisciplinary arm, patients and their informal caregivers are seen by multiple specialists at a single appointment time.	Serial Care Patients For the serial care arm, matched serial care control patients receive the current system of linear, sequential, referral-based care delivery.	Multidisciplinary Caregivers Consenting caregivers of consented multidisciplinary clinic patients (patients seen by multiple specialists at a single appointment time).	Serial Care Caregivers Consenting caregivers of consented serial care patients (patients who receive the current system of linear, sequential, referral-based care delivery).	Clinical Providers Clinical providers who referred at least 5 patients to the multidisciplinary program and consented to the study.
Baseline Intervention Death	9	16	0	0	0
Baseline Intervention Withdrawal by Subject	2	8	0	0	0
Baseline Intervention Relocation	2	0	0	0	0
Baseline Intervention Out of window for initial survey	6	13	0	0	0
Baseline Intervention Lost to Follow-up	0	5	0	0	0
Baseline Intervention Other Disease	3	0	0	0	0
3-month Follow up (Cumulative Counts) Death	33	57	0	0	0
3-month Follow up (Cumulative Counts) Lost to Follow-up	2	7	50	82	3
3-month Follow up (Cumulative Counts) Withdrawal by Subject	6	16	0	0	0
3-month Follow up (Cumulative Counts) Relocation	0	1	0	0	0
3-month Follow up (Cumulative Counts) Out of window for follow-up survey	16	36	0	0	0
6-month Follow up (Cumulative Counts) Death	51	97	0	0	0
6-month Follow up (Cumulative Counts) Lost to Follow-up	3	20	66	113	3
6-month Follow up (Cumulative Counts) Withdrawal by Subject	1	9	0	0	0
6-month Follow up (Cumulative Counts) Relocation	0	2	0	0	0

Baseline Characteristics

Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology

Baseline characteristics by cohort

Measure	Multidisciplinary Clinic Patients n=178 Participants 150 multidisciplinary clinic patients and their informal caregivers are seen by multiple specialists at a single appointment time.	Serial Care Patients n=348 Participants 300 matched serial care control patients who receive the current system of linear, sequential, referral-based care delivery.	Total n=526 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Age, Categorical Between 18 and 65 years	55 Participants n=5 Participants	147 Participants n=7 Participants	202 Participants n=5 Participants
Age, Categorical >=65 years	123 Participants n=5 Participants	201 Participants n=7 Participants	324 Participants n=5 Participants
Age, Continuous	68.85 Years STANDARD_DEVIATION 10.34 • n=5 Participants	65.79 Years STANDARD_DEVIATION 9.62 • n=7 Participants	66.83 Years STANDARD_DEVIATION 9.97 • n=5 Participants
Sex: Female, Male Female	93 Participants n=5 Participants	167 Participants n=7 Participants	260 Participants n=5 Participants
Sex: Female, Male Male	85 Participants n=5 Participants	181 Participants n=7 Participants	266 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	9 Participants n=5 Participants	3 Participants n=7 Participants	12 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	164 Participants n=5 Participants	308 Participants n=7 Participants	472 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	5 Participants n=5 Participants	37 Participants n=7 Participants	42 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants
Race (NIH/OMB) Asian	1 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Race (NIH/OMB) Black or African American	65 Participants n=5 Participants	99 Participants n=7 Participants	164 Participants n=5 Participants
Race (NIH/OMB) White	110 Participants n=5 Participants	247 Participants n=7 Participants	357 Participants n=5 Participants
Race (NIH/OMB) More than one race	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants
Region of Enrollment United States	178 Participants n=5 Participants	348 Participants n=7 Participants	526 Participants n=5 Participants
Primary Insurance Medicare	69 Participants n=5 Participants	113 Participants n=7 Participants	182 Participants n=5 Participants
Primary Insurance Medicaid	33 Participants n=5 Participants	77 Participants n=7 Participants	110 Participants n=5 Participants
Primary Insurance Commercial	66 Participants n=5 Participants	147 Participants n=7 Participants	213 Participants n=5 Participants
Primary Insurance Self-insured/None	10 Participants n=5 Participants	11 Participants n=7 Participants	21 Participants n=5 Participants
Histology Adenocarcinoma	94 Participants n=5 Participants	169 Participants n=7 Participants	263 Participants n=5 Participants
Histology Squamous Cell	55 Participants n=5 Participants	112 Participants n=7 Participants	167 Participants n=5 Participants
Histology Small Cell	20 Participants n=5 Participants	55 Participants n=7 Participants	75 Participants n=5 Participants
Histology Other	9 Participants n=5 Participants	12 Participants n=7 Participants	21 Participants n=5 Participants
ECOG 0	80 Participants n=5 Participants	118 Participants n=7 Participants	198 Participants n=5 Participants
ECOG 1	86 Participants n=5 Participants	182 Participants n=7 Participants	268 Participants n=5 Participants
ECOG 2	12 Participants n=5 Participants	43 Participants n=7 Participants	55 Participants n=5 Participants
ECOG 3	0 Participants n=5 Participants	5 Participants n=7 Participants	5 Participants n=5 Participants
Initial Stage Stage I	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Initial Stage Stage IA	38 Participants n=5 Participants	57 Participants n=7 Participants	95 Participants n=5 Participants
Initial Stage Stage IB	13 Participants n=5 Participants	26 Participants n=7 Participants	39 Participants n=5 Participants
Initial Stage Stage II	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Initial Stage Stage IIA	12 Participants n=5 Participants	21 Participants n=7 Participants	33 Participants n=5 Participants
Initial Stage Stage IIB	11 Participants n=5 Participants	22 Participants n=7 Participants	33 Participants n=5 Participants
Initial Stage Stage IIIA	48 Participants n=5 Participants	62 Participants n=7 Participants	110 Participants n=5 Participants
Initial Stage Stage IIIB	17 Participants n=5 Participants	24 Participants n=7 Participants	41 Participants n=5 Participants
Initial Stage Stage IV	39 Participants n=5 Participants	132 Participants n=7 Participants	171 Participants n=5 Participants
Initial Stage Occult Carcinoma	0 Participants n=5 Participants	2 Participants n=7 Participants	2 Participants n=5 Participants
Independently Calculated Clinical Stage Stage 0	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IA	36 Participants n=5 Participants	57 Participants n=7 Participants	93 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IB	13 Participants n=5 Participants	24 Participants n=7 Participants	37 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IIA	15 Participants n=5 Participants	16 Participants n=7 Participants	31 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IIB	13 Participants n=5 Participants	14 Participants n=7 Participants	27 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IIIA	33 Participants n=5 Participants	56 Participants n=7 Participants	89 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IIIB	16 Participants n=5 Participants	28 Participants n=7 Participants	44 Participants n=5 Participants
Independently Calculated Clinical Stage Stage IV	52 Participants n=5 Participants	152 Participants n=7 Participants	204 Participants n=5 Participants
Independently Calculated Clinical T Category T0	1 Participants n=5 Participants	4 Participants n=7 Participants	5 Participants n=5 Participants
Independently Calculated Clinical T Category T1a	35 Participants n=5 Participants	57 Participants n=7 Participants	92 Participants n=5 Participants
Independently Calculated Clinical T Category T1b	23 Participants n=5 Participants	48 Participants n=7 Participants	71 Participants n=5 Participants
Independently Calculated Clinical T Category T2a	35 Participants n=5 Participants	81 Participants n=7 Participants	116 Participants n=5 Participants
Independently Calculated Clinical T Category T2b	20 Participants n=5 Participants	40 Participants n=7 Participants	60 Participants n=5 Participants
Independently Calculated Clinical T Category T3	28 Participants n=5 Participants	50 Participants n=7 Participants	78 Participants n=5 Participants
Independently Calculated Clinical T Category T4	36 Participants n=5 Participants	66 Participants n=7 Participants	102 Participants n=5 Participants
Independently Calculated Clinical T Category Insufficient Records	0 Participants n=5 Participants	2 Participants n=7 Participants	2 Participants n=5 Participants
Independently Calculated Clinical N Category N0	92 Participants n=5 Participants	156 Participants n=7 Participants	248 Participants n=5 Participants
Independently Calculated Clinical N Category N1	13 Participants n=5 Participants	29 Participants n=7 Participants	42 Participants n=5 Participants
Independently Calculated Clinical N Category N2	46 Participants n=5 Participants	113 Participants n=7 Participants	159 Participants n=5 Participants
Independently Calculated Clinical N Category N3	27 Participants n=5 Participants	49 Participants n=7 Participants	76 Participants n=5 Participants
Independently Calculated Clinical N Category Insufficient Records	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Independently Calculated Clinical M Category M0	126 Participants n=5 Participants	196 Participants n=7 Participants	322 Participants n=5 Participants
Independently Calculated Clinical M Category M1a	14 Participants n=5 Participants	33 Participants n=7 Participants	47 Participants n=5 Participants
Independently Calculated Clinical M Category M1b	38 Participants n=5 Participants	119 Participants n=7 Participants	157 Participants n=5 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients with a test that provides tissue confirmation of the stage-defining lesion. Tests include a biopsy of any identified suspicious metastatic lesion or the primary lesion in the absence of any other suspicious lesion. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Invasive Staging, Multidisciplinary (MD) vs Serial Care (SC) Yes	108 Participants	168 Participants	—
Thoroughness of Invasive Staging, Multidisciplinary (MD) vs Serial Care (SC) No	70 Participants	180 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients with a test (i.e., biopsy) that provides tissue confirmation of the presence or absence of mediastinal nodal metastasis. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Invasive Mediastinal Staging, MD vs SC Yes	91 Participants	126 Participants	—
Thoroughness of Invasive Mediastinal Staging, MD vs SC No	87 Participants	222 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients receiving two forms of staging tests (bi-modal staging). Bi-modal staging is defined as a CT scan plus any other type of radiologic scan or any biopsy. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Bi-Modal Staging Practice, MD vs SC Yes	161 Participants	267 Participants	—
Thoroughness of Bi-Modal Staging Practice, MD vs SC No	17 Participants	81 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients receiving three forms of staging tests (tri-modal staging). Tri-modal staging is defined as a CT scan plus any other type of radiologic scan plus any biopsy, or PET/CT plus any biopsy. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Tri-Modal Staging Practice, MD vs SC Yes	99 Participants	132 Participants	—
Thoroughness of Tri-Modal Staging Practice, MD vs SC No	79 Participants	216 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients with a test that provides tissue confirmation of the stage-defining lesion. Tests include a biopsy of any identified suspicious metastatic lesion or the primary lesion in the absence of any other suspicious lesion.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Invasive Staging, MD vs SC (Conference) vs SC (no Conference) Yes	108 Participants	46 Participants	122 Participants
Thoroughness of Invasive Staging, MD vs SC (Conference) vs SC (no Conference) No	70 Participants	30 Participants	150 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients with a test (i.e., biopsy) that provides tissue confirmation of the presence or absence mediastinal nodal metastasis.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Invasive Mediastinal Staging, MD vs SC (no Conference) vs SC (Conference) Yes	91 Participants	40 Participants	86 Participants
Thoroughness of Invasive Mediastinal Staging, MD vs SC (no Conference) vs SC (Conference) No	87 Participants	36 Participants	186 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients receiving two forms of staging tests (bi-modal staging). Bi-modal staging is defined as a CT scan plus any other type of radiologic scan or any biopsy.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Bi-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference) No	17 Participants	14 Participants	67 Participants
Thoroughness of Bi-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference) Yes	161 Participants	62 Participants	205 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: All Specific Aim 3 patients (patients with histologically confirmed lung cancer (irrespective of histology) and an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) from 0 (asymptomatic) to 2 (symptomatic but out of bed for \>50% of the day)).

Number of patients receiving three forms of staging tests (tri-modal staging). Tri-modal staging is defined as a CT scan plus any other type of radiologic scan plus any biopsy, or PET/CT plus any biopsy.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Thoroughness of Tri-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference) Yes	99 Participants	39 Participants	93 Participants
Thoroughness of Tri-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference) No	79 Participants	37 Participants	179 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom appropriate treatment was given, as determined by the patients' clinical stage and treatment guidelines stipulated by the National Comprehensive Cancer Network (NCCN). 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

For Stage I or II: surgery (or radiation therapy with documented contraindication to surgery or patient refusal); for Stage III: chemotherapy and radiation therapy with or without surgery; for Stage IV: systemic therapy (or palliative care with documented patient refusal or contraindication to systemic therapy).

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=173 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=338 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Stage-Appropriateness Treatment Selection, MD vs SC Yes	140 Participants	232 Participants	—
Stage-Appropriateness Treatment Selection, MD vs SC No	33 Participants	106 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the start of a patient's first-line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom appropriate treatment was given, as determined by the patients' clinical stage and treatment guidelines stipulated by the National Comprehensive Cancer Network (NCCN).

For Stage I or II: surgery (or radiation therapy with documented contraindication to surgery or patient refusal); for Stage III: chemotherapy and radiation therapy with or without surgery; for Stage IV: systemic therapy (or palliative care with documented patient refusal or contraindication to systemic therapy).

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=173 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=73 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=265 Participants Serial care patients who were not presented in the multidisciplinary conference.
Stage-Appropriateness Treatment Selection, MD vs SC (Conference) vs SC (no Conference) Yes	140 Participants	58 Participants	174 Participants
Stage-Appropriateness Treatment Selection, MD vs SC (Conference) vs SC (no Conference) No	33 Participants	15 Participants	91 Participants

PRIMARY outcome

Timeframe: Within 48 hours of a documented care recommendation made through the multidisciplinary thoracic oncology program

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom formal, verified communication of care management decisions was made to all team members (providers inside and outside the multidisciplinary program, patients and their care-givers) within 48 hours of a care recommendation being made. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=254 Participants Serial care patients who were not presented in the multidisciplinary conference.
Timeliness of Communication, MD vs SC(Conference) Yes	168 Participants	74 Participants	242 Participants
Timeliness of Communication, MD vs SC(Conference) No	10 Participants	2 Participants	12 Participants

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the end of a patient's last line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom all recommendations made at the initial multidisciplinary conference were completed. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients. Note that two patients (one from the MD arm and one from the SC arm) have died before receiving recommendations and therefore were not analyzed for this outcome.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=177 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=75 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Concordance Rate for Initial Conference Recommendations, MD vs SC (Conference) No	37 Participants	30 Participants	—
Concordance Rate for Initial Conference Recommendations, MD vs SC (Conference) Yes	140 Participants	45 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the end of a patient's last line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom all initial conference recommendations were completed, excluding conditional recommendations for which the prior condition was not met. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients. Note that two patients (one from the MD arm and one from the SC arm) have died before receiving recommendations and therefore were not analyzed for this outcome.

E.g., if a recommendation was to have a PET/CT and then a staging biopsy if the PET showed suspicious metastatic disease, the staging biopsy recommendation was excluded from the concordance measure if the PET/CT did not happen or was negative.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=177 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=75 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Concordance Rate for Initial Conference Recommendation(s) With Prior Condition Met, MD vs SC (Conference) Yes	145 Participants	49 Participants	—
Concordance Rate for Initial Conference Recommendation(s) With Prior Condition Met, MD vs SC (Conference) No	32 Participants	26 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the end of a patient's last line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom any initial conference recommendation was completed. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients. Note that two patients (one from the MD arm and one from the SC arm) have died before receiving recommendations and therefore were not analyzed for this outcome.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=177 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=75 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Concordance Rate for Any Conference Recommendation, MD vs SC (Conference) No	3 Participants	4 Participants	—
Concordance Rate for Any Conference Recommendation, MD vs SC (Conference) Yes	174 Participants	71 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the end of a patient's last line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment.

Number of patients for whom the overall initial conference recommendation was completed. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients. Note that two patients (one from the MD arm and one from the SC arm) have died before receiving recommendations and therefore were not analyzed for this outcome.

The hierarchy to rank recommendations, from highest priority to lowest, was (1) treatment, (2) staging, (3) diagnosis, (4) surveillance.

If a patient had a treatment recommendation and it happened, he/she was concordant. If treatment was recommended and it did not happen, he/she was discordant. If no treatment recommendation was made, then concordance was measured by whether or not the staging recommendation was met. If no staging recommendation was made, then the diagnostic recommendation was given priority for a concordance measurement. If no diagnostic recommendation, then a surveillance recommendation was used to measure overall concordance.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=177 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=75 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Overall Concordance Rate Using a Hierarchy of Initial Conference Recommendations, MD vs SC (Conference) Yes	158 Participants	60 Participants	—
Overall Concordance Rate Using a Hierarchy of Initial Conference Recommendations, MD vs SC (Conference) No	19 Participants	15 Participants	—

PRIMARY outcome

Timeframe: From the time of a patient's positive lung cancer diagnosis, to the end of a patient's last line of treatment, an average of 1-2 months

Population: Patients with a conference lung cancer who enrolled in the study who did not die, or leave the study before treatment, or did not refuse treatment excluding any patient for whom prior recommendations (staging, diagnosis, surveillance) were not also completed.

Number of patients for whom the treatment recommendation made at the initial conference presentation was completed, excluding any patient for whom prior recommendations (staging, diagnosis, surveillance) were not also completed. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=101 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=46 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Concordance Rate for Treatment Recommendations With Prior Recommendations Completed, MD vs SC (Conference) Yes	87 Participants	38 Participants	—
Concordance Rate for Treatment Recommendations With Prior Recommendations Completed, MD vs SC (Conference) No	14 Participants	8 Participants	—

PRIMARY outcome

Timeframe: Baseline

Population: Patients who were offered baseline surveys (all Specific Aim 3 patients)

Number of patients who completed a baseline patient survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Baseline Patient Survey Response Rate, MD vs SC Yes	156 Participants	306 Participants	—
Baseline Patient Survey Response Rate, MD vs SC No	22 Participants	42 Participants	—

PRIMARY outcome

Timeframe: Within 30 days of 3 months after baseline survey administration

Population: Patients who were offered 3-month surveys.

Number of patients who completed a 3-month survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=156 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=306 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
3-month Patient Survey Response Rate, MD vs SC Yes	99 Participants	189 Participants	—
3-month Patient Survey Response Rate, MD vs SC No	57 Participants	117 Participants	—

PRIMARY outcome

Timeframe: Within 30 days of 6 months after baseline survey administration

Population: Patients who were offered 6-month surveys. Note that patients were offered a 6-month survey even if they did not complete a 3-month survey.

Number of patients who completed a 6-month survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=156 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=306 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
6-Month Patient Survey Response Rate, MD vs SC Yes	101 Participants	178 Participants	—
6-Month Patient Survey Response Rate, MD vs SC No	55 Participants	128 Participants	—

PRIMARY outcome

Timeframe: Baseline

Population: Patients who completed baseline surveys.

Scores from patient surveys that measure quality of life and satisfaction with care received at the time the baseline survey was taken.

Overall quality of health care - satisfaction with overall quality of health care since lung cancer diagnosis; range: 0-4 (higher is better) Financial burden of care - assessment of financial burden of care; range: 3-6 (sum of 3 items, higher is worse) Treatment decision-making: Surgery/Radiation/Chemotherapy - each 1 item; satisfaction with treatment decision-making; range: 0-2 (0=patient controlled; 1=shared decision; 2-physician decision; closer to 1 is best) Satisfaction with treatment plan - satisfaction with overall treatment plan; range: 1-5 (sum of 2 items, higher is better) Treatment decision-making: family role - satisfaction with family role in treatment decision-making; range: 0-2 (0=patient controlled; 1=shared decision; 2-physician decision; closer to 1 is best) (descriptions continued in 3 month survey description)

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=156 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=306 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Patient Survey Scores at Baseline, MD vs SC Financial burden of care	5.32 scores on a scale Standard Error 1.07	5.23 scores on a scale Standard Error 1.12	—
Patient Survey Scores at Baseline, MD vs SC Satisfaction with quality of care	16.05 scores on a scale Standard Error 2.56	13.58 scores on a scale Standard Error 3.19	—
Patient Survey Scores at Baseline, MD vs SC Overall quality of health care	3.28 scores on a scale Standard Error 0.99	3.15 scores on a scale Standard Error 0.98	—
Patient Survey Scores at Baseline, MD vs SC Treatment decision-making: Surgery	0.92 scores on a scale Standard Error 0.60	1.14 scores on a scale Standard Error 0.66	—
Patient Survey Scores at Baseline, MD vs SC Treatment decision-making: Radiation	0.97 scores on a scale Standard Error 0.64	1.10 scores on a scale Standard Error 0.60	—
Patient Survey Scores at Baseline, MD vs SC Treatment decision-making: Chemotherapy	1.03 scores on a scale Standard Error 0.66	1.01 scores on a scale Standard Error 0.63	—
Patient Survey Scores at Baseline, MD vs SC Satisfaction with treatment plan	3.95 scores on a scale Standard Error 1.54	4.31 scores on a scale Standard Error 1.20	—
Patient Survey Scores at Baseline, MD vs SC Treatment decision-making: Family role	0.73 scores on a scale Standard Error 0.56	0.69 scores on a scale Standard Error 0.53	—
Patient Survey Scores at Baseline, MD vs SC Satisfaction with physician communication	18.42 scores on a scale Standard Error 2.86	18.49 scores on a scale Standard Error 2.85	—
Patient Survey Scores at Baseline, MD vs SC Satisfaction with nurse communication	16.55 scores on a scale Standard Error 2.75	16.71 scores on a scale Standard Error 2.81	—
Patient Survey Scores at Baseline, MD vs SC Overall team satisfaction	11.69 scores on a scale Standard Error 3.41	12.24 scores on a scale Standard Error 3.39	—
Patient Survey Scores at Baseline, MD vs SC Physical well-being	24.90 scores on a scale Standard Error 7.61	24.88 scores on a scale Standard Error 6.99	—
Patient Survey Scores at Baseline, MD vs SC Social well-being	17.73 scores on a scale Standard Error 5.23	18.32 scores on a scale Standard Error 3.89	—
Patient Survey Scores at Baseline, MD vs SC Functional well-being	22.14 scores on a scale Standard Error 7.33	22.05 scores on a scale Standard Error 7.04	—
Patient Survey Scores at Baseline, MD vs SC Emotional well-being	24.23 scores on a scale Standard Error 6.04	24.04 scores on a scale Standard Error 6.00	—
Patient Survey Scores at Baseline, MD vs SC Lung cancer specific QOL	31.87 scores on a scale Standard Error 5.52	32.25 scores on a scale Standard Error 5.80	—
Patient Survey Scores at Baseline, MD vs SC Total Summary Score FACTL	121.00 scores on a scale Standard Error 21.42	121.71 scores on a scale Standard Error 21.10	—
Patient Survey Scores at Baseline, MD vs SC Generic score FACTG	89.16 scores on a scale Standard Error 18.17	89.40 scores on a scale Standard Error 17.73	—
Patient Survey Scores at Baseline, MD vs SC Trial outcome index	78.70 scores on a scale Standard Error 16.19	79.17 scores on a scale Standard Error 15.61	—
Patient Survey Scores at Baseline, MD vs SC Depression	4.44 scores on a scale Standard Error 3.91	4.92 scores on a scale Standard Error 4.08	—
Patient Survey Scores at Baseline, MD vs SC Anxiety	4.53 scores on a scale Standard Error 4.08	5.03 scores on a scale Standard Error 4.29	—

PRIMARY outcome

Timeframe: Within 30 days of 3 months after baseline survey administration

Population: Patients who completed 3-month surveys.

Scores from patient surveys that measure quality of life and satisfaction with care received at the time the 3-month survey was taken.

(continued from baseline) Satisfaction with quality of care - overall satisfaction with care received from all care team members; range: 0-18 (sum of 6 items, higher is better) Satisfaction with physician communication - overall satisfaction with physician communication; range: 0-21 (sum of 7 items, higher is better) Satisfaction with nurse communication - overall satisfaction with nurse communication; range: 0-18 (sum of 6 items, higher is better) Overall team satisfaction - CAHPS satisfaction with care from team as a whole; range: 0-15 (sum of 4 items, higher is better) Physical/Social/Functional well-being - health-related quality of life relating to physical/social/functional well-being; range 0-28 (each a sum of 7 items, higher is better) (description continues in 6 month survey description)

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=99 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=189 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Patient Survey Scores at 3 Months, MD vs SC Overall quality of health care	3.31 scores on a scale Standard Error 0.89	3.30 scores on a scale Standard Error 0.82	—
Patient Survey Scores at 3 Months, MD vs SC Financial burden of care	5.25 scores on a scale Standard Error 1.16	5.11 scores on a scale Standard Error 1.19	—
Patient Survey Scores at 3 Months, MD vs SC Treatment decision-making: Surgery	0.93 scores on a scale Standard Error 0.61	1.17 scores on a scale Standard Error 0.64	—
Patient Survey Scores at 3 Months, MD vs SC Treatment decision-making: Radiation	1.07 scores on a scale Standard Error 0.55	1.13 scores on a scale Standard Error 0.66	—
Patient Survey Scores at 3 Months, MD vs SC Treatment decision-making: Chemotherapy	0.97 scores on a scale Standard Error 0.58	1.05 scores on a scale Standard Error 0.53	—
Patient Survey Scores at 3 Months, MD vs SC Satisfaction with treatment plan	4.60 scores on a scale Standard Error 0.82	4.59 scores on a scale Standard Error 0.84	—
Patient Survey Scores at 3 Months, MD vs SC Treatment decision-making: Family role	0.72 scores on a scale Standard Error 0.50	0.74 scores on a scale Standard Error 0.47	—
Patient Survey Scores at 3 Months, MD vs SC Satisfaction with quality of care	16.09 scores on a scale Standard Error 2.36	14.33 scores on a scale Standard Error 2.30	—
Patient Survey Scores at 3 Months, MD vs SC Satisfaction with physician communication	19.03 scores on a scale Standard Error 2.34	19.01 scores on a scale Standard Error 2.10	—
Patient Survey Scores at 3 Months, MD vs SC Satisfaction with nurse communication	17.17 scores on a scale Standard Error 2.54	17.33 scores on a scale Standard Error 1.73	—
Patient Survey Scores at 3 Months, MD vs SC Overall team satisfaction	13.94 scores on a scale Standard Error 2.04	13.69 scores on a scale Standard Error 2.31	—
Patient Survey Scores at 3 Months, MD vs SC Physical well-being	25.62 scores on a scale Standard Error 7.00	26.25 scores on a scale Standard Error 7.08	—
Patient Survey Scores at 3 Months, MD vs SC Social well-being	18.42 scores on a scale Standard Error 3.85	18.92 scores on a scale Standard Error 3.25	—
Patient Survey Scores at 3 Months, MD vs SC Functional well-being	22.57 scores on a scale Standard Error 7.17	23.16 scores on a scale Standard Error 6.55	—
Patient Survey Scores at 3 Months, MD vs SC Emotional well-being	24.69 scores on a scale Standard Error 5.50	24.85 scores on a scale Standard Error 5.09	—
Patient Survey Scores at 3 Months, MD vs SC Lung cancer specific QOL	33.31 scores on a scale Standard Error 5.89	33.36 scores on a scale Standard Error 5.06	—
Patient Survey Scores at 3 Months, MD vs SC Total Summary Score FACTL	124.89 scores on a scale Standard Error 22.12	126.59 scores on a scale Standard Error 19.60	—
Patient Survey Scores at 3 Months, MD vs SC Generic score FACTG	91.67 scores on a scale Standard Error 18.33	93.16 scores on a scale Standard Error 16.53	—
Patient Survey Scores at 3 Months, MD vs SC Trial outcome index	81.39 scores on a scale Standard Error 17.03	82.77 scores on a scale Standard Error 15.14	—
Patient Survey Scores at 3 Months, MD vs SC Depression	5.37 scores on a scale Standard Error 4.15	4.81 scores on a scale Standard Error 3.96	—
Patient Survey Scores at 3 Months, MD vs SC Anxiety	4.79 scores on a scale Standard Error 4.02	4.50 scores on a scale Standard Error 4.01	—

PRIMARY outcome

Timeframe: Within 30 days of 6 months after baseline survey administration

Population: Patients who completed 6-month surveys.

Scores from patient surveys that measure quality of life and satisfaction with care received at the time the 6-month survey was taken.

(cont) Emotional well-being - health-related quality of life related to emotional well-being; range 0-30 (sum of 6 items, higher is better) Lung cancer specific QOL - health-related quality of life related to lung cancer diagnosis; range: 0-36 (sum of 9 items, higher is better) Total Summary Score FACTL - full survey, functional assessment of cancer therapy - lung; range: 0-136 (sum of 36 items, higher is better) Generic Score FACTG - full survey, functional assessment of cancer therapy - general; range: 0-108 (sum of 27 items, higher is better) Trial Outcome Index - health related quality of life - trial outcome index; range: 0-84 (sum of 23 items, higher is better) Depression/Anxiety - depression/anxiety measured by Hospital Anxiety and Depression Scale; range: 0-21 (sum of 7 items each, higher is worse)

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=101 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=178 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Patient Survey Scores at 6 Months, MD vs SC Overall quality of health care	3.36 scores on a scale Standard Error 0.74	3.15 scores on a scale Standard Error 0.87	—
Patient Survey Scores at 6 Months, MD vs SC Financial burden of care	5.48 scores on a scale Standard Error 0.99	5.06 scores on a scale Standard Error 1.30	—
Patient Survey Scores at 6 Months, MD vs SC Treatment decision-making: Surgery	1.15 scores on a scale Standard Error 0.55	1.09 scores on a scale Standard Error 0.58	—
Patient Survey Scores at 6 Months, MD vs SC Treatment decision-making: Radiation	1.09 scores on a scale Standard Error 0.62	1.05 scores on a scale Standard Error 0.67	—
Patient Survey Scores at 6 Months, MD vs SC Satisfaction with treatment plan	4.89 scores on a scale Standard Error 0.46	4.58 scores on a scale Standard Error 0.99	—
Patient Survey Scores at 6 Months, MD vs SC Treatment decision-making: Chemo	1.15 scores on a scale Standard Error 0.55	1.06 scores on a scale Standard Error 0.61	—
Patient Survey Scores at 6 Months, MD vs SC Treatment decision-making: Family role	0.83 scores on a scale Standard Error 0.42	0.75 scores on a scale Standard Error 0.54	—
Patient Survey Scores at 6 Months, MD vs SC Satisfaction with quality of care	15.89 scores on a scale Standard Error 2.21	14.41 scores on a scale Standard Error 2.55	—
Patient Survey Scores at 6 Months, MD vs SC Satisfaction with physician communication	19.33 scores on a scale Standard Error 1.50	19.08 scores on a scale Standard Error 1.85	—
Patient Survey Scores at 6 Months, MD vs SC Satisfaction with nurse communication	17.32 scores on a scale Standard Error 1.88	17.04 scores on a scale Standard Error 2.27	—
Patient Survey Scores at 6 Months, MD vs SC Overall team satisfaction	14.19 scores on a scale Standard Error 1.59	13.73 scores on a scale Standard Error 2.17	—
Patient Survey Scores at 6 Months, MD vs SC Physical well-being	28.46 scores on a scale Standard Error 5.59	26.94 scores on a scale Standard Error 6.39	—
Patient Survey Scores at 6 Months, MD vs SC Social well-being	18.62 scores on a scale Standard Error 3.78	18.29 scores on a scale Standard Error 3.80	—
Patient Survey Scores at 6 Months, MD vs SC Functional well-being	24.22 scores on a scale Standard Error 6.07	23.41 scores on a scale Standard Error 6.54	—
Patient Survey Scores at 6 Months, MD vs SC Emotional well-being	26.15 scores on a scale Standard Error 4.63	25.26 scores on a scale Standard Error 4.72	—
Patient Survey Scores at 6 Months, MD vs SC Lung cancer specific QOL	34.49 scores on a scale Standard Error 5.96	33.59 scores on a scale Standard Error 5.74	—
Patient Survey Scores at 6 Months, MD vs SC Total Summary Score FACTL	132.00 scores on a scale Standard Error 18.26	128.00 scores on a scale Standard Error 19.92	—
Patient Survey Scores at 6 Months, MD vs SC Generic score FACTG	97.61 scores on a scale Standard Error 14.19	94.26 scores on a scale Standard Error 15.89	—
Patient Survey Scores at 6 Months, MD vs SC Trial outcome index	86.92 scores on a scale Standard Error 14.39	83.96 scores on a scale Standard Error 15.56	—
Patient Survey Scores at 6 Months, MD vs SC Depression	4.07 scores on a scale Standard Error 3.31	4.81 scores on a scale Standard Error 4.03	—
Patient Survey Scores at 6 Months, MD vs SC Anxiety	3.99 scores on a scale Standard Error 3.99	4.65 scores on a scale Standard Error 3.72	—

PRIMARY outcome

Timeframe: Baseline

Population: Caregivers who completed surveys

Number of caregivers who completed a baseline patient survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=100 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=144 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Baseline Caregiver Survey Response Rate, MD vs SC Yes	100 Participants	144 Participants	—
Baseline Caregiver Survey Response Rate, MD vs SC No	0 Participants	0 Participants	—

PRIMARY outcome

Timeframe: Within 30 days of 3 months after baseline survey administration

Population: Caregivers who completed surveys

Number of caregivers who completed a 3-month survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=100 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=144 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
3-month Caregiver Survey Response Rate, MD vs SC Yes	50 Participants	62 Participants	—
3-month Caregiver Survey Response Rate, MD vs SC No	50 Participants	82 Participants	—

PRIMARY outcome

Timeframe: Within 30 days of 6 months after baseline survey administration

Population: Caregivers who completed surveys

Number of caregivers who completed a 6-month survey

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=100 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=144 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
6-Month Caregiver Survey Response Rate, MD vs SC Yes	34 Participants	31 Participants	—
6-Month Caregiver Survey Response Rate, MD vs SC No	66 Participants	113 Participants	—

PRIMARY outcome

Timeframe: Baseline

Scores from caregiver surveys that measure quality of life and satisfaction with care received at the time the baseline survey was taken.

Overall quality of health care - satisfaction with overall quality of health care since lung cancer diagnosis; range:0-4 (higher is better) Treatment decision-making: Surgery/Radiation/Chemotherapy - each 1 item; satisfaction with treatment decision-making; range: 0-2 (0=patient controlled; 1=shared decision; 2-physician decision; closer to 1 is best) Treatment decision-making: family role - satisfaction with family role in treatment decision-making; range: 0-2 (0=patient controlled; 1=shared decision; 2-physician decision; closer to 1 is best) Satisfaction with treatment plan - satisfaction with overall treatment plan; range: 0-2 (higher is better) Satisfaction patient can complete treatment plan; range: 0-2 (higher is better) (continued in 3 month survey description)

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=100 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=144 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Caregiver Survey Scores at Baseline, MD vs SC Overall quality of health care	3.27 scores on a scale Standard Error 0.98	3.14 scores on a scale Standard Error 0.95	—
Caregiver Survey Scores at Baseline, MD vs SC Treatment decision-making: Surgery	0.78 scores on a scale Standard Error 0.65	0.90 scores on a scale Standard Error 0.71	—
Caregiver Survey Scores at Baseline, MD vs SC Treatment decision-making: Radiation	0.94 scores on a scale Standard Error 0.69	1.03 scores on a scale Standard Error 0.67	—
Caregiver Survey Scores at Baseline, MD vs SC Treatment decision-making: Chemo	0.88 scores on a scale Standard Error 0.59	0.98 scores on a scale Standard Error 0.63	—
Caregiver Survey Scores at Baseline, MD vs SC Treatment decision-making: Family role	0.68 scores on a scale Standard Error 0.50	0.73 scores on a scale Standard Error 0.52	—
Caregiver Survey Scores at Baseline, MD vs SC Satisfaction with treatment plan	1.40 scores on a scale Standard Error 0.83	1.61 scores on a scale Standard Error 0.66	—
Caregiver Survey Scores at Baseline, MD vs SC Satisfaction patient can complete treatment plan	1.44 scores on a scale Standard Error 0.80	1.63 scores on a scale Standard Error 0.68	—
Caregiver Survey Scores at Baseline, MD vs SC Satisfaction with quality of care	16.41 scores on a scale Standard Error 2.57	13.90 scores on a scale Standard Error 2.94	—
Caregiver Survey Scores at Baseline, MD vs SC Satisfaction with physician communication	18.95 scores on a scale Standard Error 2.48	18.76 scores on a scale Standard Error 2.52	—
Caregiver Survey Scores at Baseline, MD vs SC Satisfaction with nurse communication	21.96 scores on a scale Standard Error 4.29	22.46 scores on a scale Standard Error 3.68	—
Caregiver Survey Scores at Baseline, MD vs SC Overall team satisfaction	10.66 scores on a scale Standard Error 2.29	10.57 scores on a scale Standard Error 2.29	—
Caregiver Survey Scores at Baseline, MD vs SC Depression	3.12 scores on a scale Standard Error 3.49	3.76 scores on a scale Standard Error 3.45	—
Caregiver Survey Scores at Baseline, MD vs SC Anxiety	6.57 scores on a scale Standard Error 4.45	6.90 scores on a scale Standard Error 4.77	—
Caregiver Survey Scores at Baseline, MD vs SC Physical Functioning QOL	78.23 scores on a scale Standard Error 27.38	77.24 scores on a scale Standard Error 25.88	—
Caregiver Survey Scores at Baseline, MD vs SC Physical health problems QOL	74.49 scores on a scale Standard Error 38.46	68.71 scores on a scale Standard Error 42.04	—
Caregiver Survey Scores at Baseline, MD vs SC Pain QOL	81.89 scores on a scale Standard Error 26.14	80.32 scores on a scale Standard Error 28.98	—
Caregiver Survey Scores at Baseline, MD vs SC General health perceptions	72.13 scores on a scale Standard Error 19.63	69.35 scores on a scale Standard Error 21.04	—
Caregiver Survey Scores at Baseline, MD vs SC Energy/Fatigue QOL	57.66 scores on a scale Standard Error 21.02	59.04 scores on a scale Standard Error 20.62	—
Caregiver Survey Scores at Baseline, MD vs SC Social Functioning QOL	78.98 scores on a scale Standard Error 26.60	76.97 scores on a scale Standard Error 24.83	—
Caregiver Survey Scores at Baseline, MD vs SC Emotional health problems QOL	74.75 scores on a scale Standard Error 40.15	72.77 scores on a scale Standard Error 40.61	—
Caregiver Survey Scores at Baseline, MD vs SC Emotional well-being QOL	65.09 scores on a scale Standard Error 22.96	68.33 scores on a scale Standard Error 19.17	—

PRIMARY outcome

Timeframe: Within 30 days of 3 months after baseline survey administration

Scores from caregiver surveys that measure quality of life and satisfaction with care received at the time the 3-month survey was taken.

(cont) Satisfaction with quality of care - overall satisfaction with care received from all care team members; range: 0-18 (sum of 6 items, higher is better) Satisfaction with physician communication - overall satisfaction with physician communication; range: 0-28 (sum of 7 items, higher is better) Satisfaction with nurse communication - overall satisfaction with nurse communication; range: 6-24 (sum of 6 items, higher is better) Overall team satisfaction - CAHPS satisfaction with care from team as a whole; range: 0-15 (sum of 4 items, higher is better) Depression/Anxiety - depression/anxiety measured by Hospital Anxiety and Depression Scale; range: 0-21 (sum of 7 items, higher is worse) (continued in 6 month survey description)

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=50 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=62 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Caregiver Survey Scores at 3 Months, MD vs SC Satisfaction patient can complete treatment plan	1.86 scores on a scale Standard Error 0.42	1.89 scores on a scale Standard Error 0.32	—
Caregiver Survey Scores at 3 Months, MD vs SC Satisfaction with quality of care	16.82 scores on a scale Standard Error 2.14	14.54 scores on a scale Standard Error 2.38	—
Caregiver Survey Scores at 3 Months, MD vs SC Satisfaction with physician communication	19.30 scores on a scale Standard Error 1.63	19.22 scores on a scale Standard Error 2.45	—
Caregiver Survey Scores at 3 Months, MD vs SC Satisfaction with nurse communication	23.36 scores on a scale Standard Error 1.66	23.28 scores on a scale Standard Error 2.59	—
Caregiver Survey Scores at 3 Months, MD vs SC Overall team satisfaction	11.52 scores on a scale Standard Error 0.89	11.46 scores on a scale Standard Error 1.13	—
Caregiver Survey Scores at 3 Months, MD vs SC Depression	3.72 scores on a scale Standard Error 3.10	3.04 scores on a scale Standard Error 3.10	—
Caregiver Survey Scores at 3 Months, MD vs SC Anxiety	6.20 scores on a scale Standard Error 4.10	6.04 scores on a scale Standard Error 5.05	—
Caregiver Survey Scores at 3 Months, MD vs SC Physical Functioning QOL	76.92 scores on a scale Standard Error 26.13	73.67 scores on a scale Standard Error 27.78	—
Caregiver Survey Scores at 3 Months, MD vs SC Physical health problems QOL	68.37 scores on a scale Standard Error 38.79	63.43 scores on a scale Standard Error 42.26	—
Caregiver Survey Scores at 3 Months, MD vs SC Pain QOL	68.37 scores on a scale Standard Error 38.79	63.43 scores on a scale Standard Error 42.26	—
Caregiver Survey Scores at 3 Months, MD vs SC General health perceptions	73.90 scores on a scale Standard Error 20.16	69.14 scores on a scale Standard Error 20.44	—
Caregiver Survey Scores at 3 Months, MD vs SC Energy/Fatigue QOL	57.70 scores on a scale Standard Error 18.30	58.30 scores on a scale Standard Error 16.79	—
Caregiver Survey Scores at 3 Months, MD vs SC Social Functioning QOL	73.60 scores on a scale Standard Error 27.08	80.19 scores on a scale Standard Error 23.03	—
Caregiver Survey Scores at 3 Months, MD vs SC Emotional health problems QOL	62.67 scores on a scale Standard Error 40.76	67.28 scores on a scale Standard Error 43.19	—
Caregiver Survey Scores at 3 Months, MD vs SC Emotional well-being QOL	68.37 scores on a scale Standard Error 14.61	67.80 scores on a scale Standard Error 20.82	—
Caregiver Survey Scores at 3 Months, MD vs SC Overall quality of health care	3.32 scores on a scale Standard Error 0.96	3.55 scores on a scale Standard Error 0.67	—
Caregiver Survey Scores at 3 Months, MD vs SC Treatment decision-making: Surgery	0.71 scores on a scale Standard Error 0.69	1.08 scores on a scale Standard Error 0.65	—
Caregiver Survey Scores at 3 Months, MD vs SC Treatment decision-making: Radiation	0.90 scores on a scale Standard Error 0.60	1.00 scores on a scale Standard Error 0.58	—
Caregiver Survey Scores at 3 Months, MD vs SC Treatment decision-making: Chemo	0.78 scores on a scale Standard Error 0.64	1.13 scores on a scale Standard Error 0.58	—
Caregiver Survey Scores at 3 Months, MD vs SC Treatment decision-making: Family role	0.64 scores on a scale Standard Error 0.53	0.75 scores on a scale Standard Error 0.48	—
Caregiver Survey Scores at 3 Months, MD vs SC Satisfaction with treatment plan	1.80 scores on a scale Standard Error 0.49	1.81 scores on a scale Standard Error 0.44	—

PRIMARY outcome

Timeframe: Within 30 days of 6 months after baseline survey administration

Scores from caregiver surveys that measure quality of life and satisfaction with care received at the time the 6-month survey was taken.

(cont) Physical Functioning QOL - 10 items; Physical Health Problems QOL - 4 items; Pain QOL - 2 items; General health perceptions - 5 items; Energy/fatigue QOL - 4 items; Social Functioning QOL - 2 items; Emotional health problems QOL - 3 items; Emotional well-being QOL - 5 items.

All health related quality of life measures are from the SF-36 survey tool, and use a range of 0-100 mean score (higher is better).

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=34 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=31 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Caregiver Survey Scores at 6 Months, MD vs SC Overall quality of health care	3.24 scores on a scale Standard Error 0.87	3.23 scores on a scale Standard Error 0.92	—
Caregiver Survey Scores at 6 Months, MD vs SC Treatment decision-making: Surgery	1.05 scores on a scale Standard Error 0.67	0.91 scores on a scale Standard Error 0.70	—
Caregiver Survey Scores at 6 Months, MD vs SC Treatment decision-making: Radiation	1.05 scores on a scale Standard Error 0.83	0.88 scores on a scale Standard Error 0.70	—
Caregiver Survey Scores at 6 Months, MD vs SC Treatment decision-making: Chemo	1.03 scores on a scale Standard Error 0.68	1.00 scores on a scale Standard Error 0.71	—
Caregiver Survey Scores at 6 Months, MD vs SC Treatment decision-making: Family role	0.78 scores on a scale Standard Error 0.49	0.76 scores on a scale Standard Error 0.54	—
Caregiver Survey Scores at 6 Months, MD vs SC Satisfaction with treatment plan	1.79 scores on a scale Standard Error 0.48	1.86 scores on a scale Standard Error 0.35	—
Caregiver Survey Scores at 6 Months, MD vs SC Satisfaction patient can complete treatment plan	1.78 scores on a scale Standard Error 0.58	1.72 scores on a scale Standard Error 0.57	—
Caregiver Survey Scores at 6 Months, MD vs SC Satisfaction with quality of care	16.33 scores on a scale Standard Error 2.20	14.14 scores on a scale Standard Error 2.96	—
Caregiver Survey Scores at 6 Months, MD vs SC Satisfaction with physician communication	19.27 scores on a scale Standard Error 2.41	19.50 scores on a scale Standard Error 1.44	—
Caregiver Survey Scores at 6 Months, MD vs SC Satisfaction with nurse communication	22.88 scores on a scale Standard Error 3.50	23.36 scores on a scale Standard Error 1.71	—
Caregiver Survey Scores at 6 Months, MD vs SC Overall team satisfaction	11.27 scores on a scale Standard Error 1.42	11.73 scores on a scale Standard Error 0.77	—
Caregiver Survey Scores at 6 Months, MD vs SC Depression	2.97 scores on a scale Standard Error 2.89	3.45 scores on a scale Standard Error 2.91	—
Caregiver Survey Scores at 6 Months, MD vs SC Anxiety	5.42 scores on a scale Standard Error 3.67	5.23 scores on a scale Standard Error 3.01	—
Caregiver Survey Scores at 6 Months, MD vs SC Physical Functioning QOL	75.15 scores on a scale Standard Error 28.84	79.67 scores on a scale Standard Error 25.10	—
Caregiver Survey Scores at 6 Months, MD vs SC Physical health problems QOL	73.48 scores on a scale Standard Error 41.43	69.32 scores on a scale Standard Error 46.25	—
Caregiver Survey Scores at 6 Months, MD vs SC Pain QOL	81.44 scores on a scale Standard Error 25.41	84.66 scores on a scale Standard Error 28.85	—
Caregiver Survey Scores at 6 Months, MD vs SC General health perceptions	74.09 scores on a scale Standard Error 17.30	62.95 scores on a scale Standard Error 21.31	—
Caregiver Survey Scores at 6 Months, MD vs SC Energy/Fatigue QOL	59.75 scores on a scale Standard Error 22.51	54.85 scores on a scale Standard Error 15.39	—
Caregiver Survey Scores at 6 Months, MD vs SC Social Functioning QOL	76.59 scores on a scale Standard Error 24.15	80.91 scores on a scale Standard Error 24.96	—
Caregiver Survey Scores at 6 Months, MD vs SC Emotional health problems QOL	72.73 scores on a scale Standard Error 40.36	74.24 scores on a scale Standard Error 42.33	—
Caregiver Survey Scores at 6 Months, MD vs SC Emotional well-being QOL	67.60 scores on a scale Standard Error 18.43	63.33 scores on a scale Standard Error 18.31	—

PRIMARY outcome

Timeframe: From the time of a patient's initial lesion detection to the designated step in the care process, as noted per row below

Population: Not every patient went to every step, therefore the times only include patients that completed that step.

Aggregate time in days from enrollment to a specific care delivery endpoint including: from initial detection of lesion to initial biopsy, from initial detection to non-invasive staging, from initial detection to invasive staging, and from initial detection to definitive treatment. 2 group comparison between Multidisciplinary Clinic Patients and Serial Care Patients.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Timeliness of Care, MD vs SC From Initial detection of lesion to initial biopsy	25 Days Interval 9.0 to 71.0	15 Days Interval 4.0 to 40.0	—
Timeliness of Care, MD vs SC From initial detection to non-invasive staging	20 Days Interval 8.0 to 44.0	16 Days Interval 3.0 to 40.0	—
Timeliness of Care, MD vs SC From initial detection to invasive staging	29 Days Interval 16.0 to 79.0	20 Days Interval 6.0 to 61.0	—
Timeliness of Care, MD vs SC From initial detection to definitive treatment	60 Days Interval 41.0 to 139.0	57 Days Interval 33.0 to 93.0	—

PRIMARY outcome

Timeframe: From the time of a patient's initial lesion detection to the designated step in the care process, as noted per row below

Population: Not every patient went to every step, therefore the times only include patients that completed that step.

Aggregate time in days from enrollment to specific care delivery endpoint including: from initial detection of lesion to initial biopsy, from initial detection to non-invasive staging, from initial detection to invasive staging, and from initial detection to definitive treatment.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Timeliness of Care, MD vs SC (Conference) vs SC (no Conference) From Initial detection of lesion to initial biopsy	25 Days Interval 9.0 to 71.0	18.5 Days Interval 4.0 to 40.0	13 Days Interval 4.0 to 40.0
Timeliness of Care, MD vs SC (Conference) vs SC (no Conference) From initial detection to non-invasive staging	20 Days Interval 8.0 to 44.0	18 Days Interval 6.0 to 40.0	16 Days Interval 3.0 to 42.0
Timeliness of Care, MD vs SC (Conference) vs SC (no Conference) Initial detection of lesion to invasive staging	29 Days Interval 16.0 to 79.0	40 Days Interval 9.0 to 80.0	14 Days Interval 5.0 to 48.0
Timeliness of Care, MD vs SC (Conference) vs SC (no Conference) From initial detection to definitive treatment	60 Days Interval 41.0 to 139.0	69 Days Interval 44.0 to 160.0	54 Days Interval 30.0 to 90.0

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Very Satisfied	9 Participants	7 Participants	5 Participants
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Satisfied	2 Participants	1 Participants	0 Participants
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Somewhat dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - Ease of Referring Patients to the Conference Very Dissatisfied	0 Participants	0 Participants	0 Participants

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference Very satisfied	10 Participants	7 Participants	5 Participants
Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference Satisfied	1 Participants	1 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference Very Dissatisfied	0 Participants	0 Participants	0 Participants

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Very Satisfied	10 Participants	8 Participants	5 Participants
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Satisfied	1 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Somewhat dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients Very Dissatisfied	0 Participants	0 Participants	0 Participants

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Very Satisfied	10 Participants	6 Participants	5 Participants
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Somewhat dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Satisfied	1 Participants	2 Participants	0 Participants
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient Very Dissatisfied	0 Participants	0 Participants	0 Participants

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient Very Satisfied	10 Participants	7 Participants	5 Participants
Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient Satisfied	1 Participants	1 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient Very Dissatisfied	0 Participants	0 Participants	0 Participants

PRIMARY outcome

Timeframe: After a provider referred their 5th patient to the multidisciplinary conference (baseline), then within 30 days of 6 months and 12 months, respectively, after baseline survey was completed

Population: Any clinical provider who referred at least 5 patients to the multidisciplinary program and consented to take satisfaction surveys.

Responses from clinical providers will measure provider satisfaction and obstacles to institutional multidisciplinary care.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=11 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=8 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=5 Participants Serial care patients who were not presented in the multidisciplinary conference.
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Very Satisfied	10 Participants	7 Participants	5 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Somewhat satisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Somewhat dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment Very Dissatisfied	0 Participants	0 Participants	0 Participants
Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment N/A	1 Participants	1 Participants	0 Participants

PRIMARY outcome

Timeframe: As measured from the time from cancer diagnosis to death or data censor, up to 6 years

Overall survival, defined as the time from cancer diagnosis to death from any cause or data censoring, is analyzed and summarized with the survival probabilities over time using the Kaplan-Meier method. Confidence intervals for the 1- and 3- year survival probabilities are reported. Additionally, the Cox proportional hazard model was used to estimate hazard ratios which are reported in the statistical analyses with 95% confidence intervals.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Patient Overall Survival 1-year overall survival estimate	0.58 survival probability Interval 0.51 to 0.65	0.60 survival probability Interval 0.54 to 0.65	—
Patient Overall Survival 3-year overall survival estimate	0.34 survival probability Interval 0.27 to 0.41	0.36 survival probability Interval 0.31 to 0.41	—

PRIMARY outcome

Timeframe: As measured from the time from cancer diagnosis to death or data censor, up to 6 years

Overall survival, defined as the time from cancer diagnosis to death from any cause or data censoring, is analyzed and summarized with the survival probabilities over time using the Kaplan-Meier method. Confidence intervals for the 1- and 3- year survival probabilities are reported. Additionally, the Cox proportional hazard model was used to estimate hazard ratios which are reported in the statistical analyses with 95% confidence intervals.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Patient Overall Survival With SC Further Broken Down 1-year overall survival estimate	0.58 survival probability Interval 0.51 to 0.65	0.64 survival probability Interval 0.53 to 0.74	0.58 survival probability Interval 0.52 to 0.64
Patient Overall Survival With SC Further Broken Down 3-year overall survival estimate	0.34 survival probability Interval 0.27 to 0.41	0.41 survival probability Interval 0.3 to 0.52	0.34 survival probability Interval 0.29 to 0.4

PRIMARY outcome

Timeframe: measured from the time from cancer diagnosis to disease progression, death, or data censoring, up to 6 years

Event-free survival (EFS), as measured from the time from cancer diagnosis to disease progression, death, or data censoring, is analyzed and summarized with the survival probabilities over time using the Kaplan-Meier method. Confidence intervals for the 1- and 3- year survival probabilities are reported. Additionally, the Cox proportional hazard model was used to estimate hazard ratios which are reported in the statistical analyses with 95% confidence intervals.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=348 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference Serial care patients who were not presented in the multidisciplinary conference.
Patient Disease/Progression Free Survival 1-year EFS survival estimate	0.45 survival probability Interval 0.38 to 0.53	0.48 survival probability Interval 0.43 to 0.53	—
Patient Disease/Progression Free Survival 3-year EFS survival estimate	0.26 survival probability Interval 0.2 to 0.33	0.26 survival probability Interval 0.21 to 0.31	—

PRIMARY outcome

Timeframe: As measured from the time from cancer diagnosis to death or data censor, up to 6 years

Event-free survival (EFS), as measured from the time from cancer diagnosis to disease progression, death, or data censoring, is analyzed and summarized with the survival probabilities over time using the Kaplan-Meier method. Confidence intervals for the 1- and 3- year survival probabilities are reported. Additionally, the Cox proportional hazard model was used to estimate hazard ratios which are reported in the statistical analyses with 95% confidence intervals.

This measure compares 3 groups, instead of 2, because some patients in the serial care group were presented for discussion in a multidisciplinary thoracic oncology conference while still not being seen in the multidisciplinary clinic setting. Therefore, we split the serial care group in two in order to measure the potential impact of a multidisciplinary conference model, separate from the multidisciplinary clinic model.

Outcome measures

Measure	Multidisciplinary Clinic Caregivers n=178 Participants Multidisciplinary clinic informal caregivers of patients who are seen by multiple specialists at a single appointment time.	Serial Care Caregivers n=76 Participants Serial care control caregivers whose patients received the current system of linear, sequential, referral-based care delivery.	Serial Care Patients Not Presented in Conference n=272 Participants Serial care patients who were not presented in the multidisciplinary conference.
Patient Disease/Progression Free Survival With SC Further Broken Down 1-year EFS survival estimate	0.45 survival probability Interval 0.38 to 0.53	0.55 survival probability Interval 0.43 to 0.65	0.46 survival probability Interval 0.4 to 0.52
Patient Disease/Progression Free Survival With SC Further Broken Down 3-year EFS survival estimate	0.26 survival probability Interval 0.2 to 0.33	0.32 survival probability Interval 0.22 to 0.43	0.24 survival probability Interval 0.19 to 0.29

Adverse Events

Multidisciplinary Clinic Patients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 125 deaths

Serial Care Patients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 239 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Raymond Osarogiagbon

Baptist Cancer Center

Phone: 901-752-6131

Email: Raymond.Osarogiagbon@bmg.md

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place