The Right Information and Right Care for the Right Patient at the Right Time (4R) Oncology model for team-based interdependent care delivery and patient self-management was effectively optimized for a diverse care team across multiple institutions. These findings were published in JCO Oncology Practice.

Cancer is a complex disease that requires interdependent care models coordinated across multiple disciplines. This study evaluated whether the 4R Oncology model may improve team coordination in the setting of breast and lung cancers. At 4 Kaiser Permanente Northern California (KPNC) sites between 2020 and 2021, a team committed to optimizing the 4R Oncology model to improve the delivery of multidisciplinary care.

Over time, the team expanded from 10 team members to 24 (3 external) as the 4R model was optimized. The team members agreed on the structure and organization of the team, which comprised subteams. Some members joined multiple subteams.

Continue Reading

After 40 optimizations (22 in breast cancer; 7 in lung cancer; and 11 in both), the final Care Sequence was:

  • Care initiation
  • Surgery
  • Neoadjuvant therapy
  • Adjuvant therapy
  • Treatment for advanced disease (lung cancer only)
  • Chemoradiation (lung cancer only).

Most optimizations required low or medium team member effort. The optimizations improved process efficacy for 77% of breast cancer optimizations, 64% of both cancer optimizations, and all lung cancer optimizations.

Overall, the 4R Oncology model established learning, problem-solving, and adaptation processing in the team.

The major limitation of this care model was that survivorship was not included.

“Our results suggest that 4R may be an effective approach to teamwork and could contribute to viability of the oncology workforce. Our intervention and taxonomy of the results may serve as a blueprint for other institutions motivated to strengthen teamwork,” the researchers concluded.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Liu R, Weldon CB, Linehan E, et al. Fostering a high-functioning team in cancer care using the 4R Oncology model: assessment in a large health system and a blueprint for other institutions. JCO Oncol Pract. 2022;OP2200287. doi:10.1200/OP.22.00287