Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision‐Making

Abstract

BackgroundMultidisciplinary team (MDT)-driven cancer care is a mandatory UK national policy, widely used globally. However, few studies have examined how MDT members make decisions as a team. We report a single-centre prospective study on team working within breast cancer MDT.MethodsThis was a prospective observational study of 10 breast MDT meetings (MDM). Trained clinical observer scored quality of presented information and disciplinary contribution to case reviews in real time, using a validated tool, namely Metric for the Observation of Decision-Making. Data were analysed to evaluate quality of team working.ResultsTen MDMs were observed (N = 346 patients). An average of 42 patients were discussed per MDM (range: 29–51) with an average 3 min 20 s (range: 31 s–9 min) dedicated to each patient. Management decision was made in 99% of cases. In terms of contribution to case reviews, breast care nurses scored significantly (p < 0.05) lower (M = 1.79, SD = 0.12) compared to other team members (e.g. surgeons, M = 4.65; oncologists, M = 3.07; pathologists, M = 4.51; radiologists, M = 3.21). Information on patient psychosocial aspects (M = 1.69, SD = 0.68), comorbidities (M = 1.36, SD = 0.39) and views on treatment options (M = 1.47, SD = 0.34) was also significantly (p < 0.05) less well represented compared to radiology (M = 3.62, SD = 0.77), pathology (M = 4.42, SD = 0.49) and patient history (M = 3.91, SD = 0.48).ConclusionMDT evaluation via direct observation in a meeting is feasible and reliable. We found consistent levels of quality of information coverage and contribution within the team, but certain aspects could be improved. Contribution to patient review resides predominantly with surgeons, while presented patient information is largely of biomedical nature. These findings can be fed to cancer MDTs to identify potential interventions for improvement.

Development and validation of a short version of the Metric for the Observation of Decision-making in multidisciplinary tumor boards: MODe-Lite

“…Its broader impact on the literature surrounding MTB transformation has been demonstrated by the number of citations the development studies have accrued. MODe has been used by researchers: from use as a standalone assessment method in order to increase the understanding of team behaviours in MTB meetings, 11,13 to use in complex interventional studies alongside other performance metrics in order to assess the impact of interventions on aspects of team decision making. 10 This flexibility has undoubtedly increased the uptake of the tool.…”

“…4,[7][8][9] MODe has been used to assess decision-making processes across different tumour types in a number of different countries (Box 1). [7][8][9][10][11][12][13][14][15][16][17][18][19] MODe has been applied to show that the ability of an MTB to reach a clinical decision was positively associated with high-quality comprehensive and necessary information available at the point of decision-making (from case history, radiology, pathology), team contribution, 4,[9][10] and cases that are discussed at the beginning of meetings. [10][11] However, high-quality information and team contribution were positively correlated with the larger team size and longer case discussions.…”

Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study

“…To our knowledge, no studies have evaluated and reported the responses of lung cancer MDT members to data presentation and feedback using a mixed‐methods approach. Several studies investigate aspects of MDT practice (from lung cancer and other streams), including processes, reporting to general practitioners, data characteristics, and timing of MDT discussion . The systematic review by Prades et al includes three papers that focus on aspects of lung cancer MDT care.…”

“…From studies involving other tumor streams, a UK study of comorbidity data collection by a single‐center colorectal cancer MDT showed a marked improvement with the introduction of routine ACE‐27 index calculation in surgical clinics prior to the MDT (increasing from 54% to 100% comorbidity data availability post‐intervention). A UK observational study of serial breast cancer MDT meetings in a single center identified higher quality biomedical information (history, radiology, and pathology) compared with patient‐related information (psychosocial, comorbidities, and patient views) as scored by the previously published MDT‐MODe assessment tool . Relatively few studies investigate multidisciplinary clinical care with qualitative methods.…”

“…A recent systematic review of studies addressing the organization of MDTs identified data issues, including quality of facilities, online and computing needs, and administrative support . Other MDT data‐related topics investigated in a range of tumor streams include gaps in comorbidity data, standardized reporting to general practitioners, possible deficiencies in collection of patient‐related factors, and optimal timing of MDT presentation …”