Degrees of Multidisciplinarity Underpinning Care Planning for Patients with Cancer in Weekly Multidisciplinary Team Meetings: Conversation Analysis

Abstract

Purpose Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK’s Department of Health, UK’s National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. Patients and Methods This is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the ‘Orientation-Discussion-Decision-Implementation’ framework, and the cancer guidelines. Results Eight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team. Conclusion We found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guidelines, and just over 10% not adhering to the group decision-making framework. The findings are in line with the UK recommendation on streamlining MDT meetings and could help decide how to re-organise the meetings to be most efficient. Implications are discussed in relation to quality and safety of care.

The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives

“…The reasons for growing workload are numerous, including increased cancer incidence, cancer survival, comorbidities, population size, and longevity [11,[25][26][27][28][29]. In addition, perhaps due to the success of the MDT model, many straightforward or non-cancerous cases are put through the MDT meeting [30]. It appears that healthcare professionals appreciate the benefits of the MDT and feel confident in the safety net it provides for a range of cases, although there are growing concerns that clinicians now fear making clinical decisions without the approval of the MDT [31].…”

Decision-Making in Multidisciplinary Tumor Boards in Breast Cancer Care – An Observational Study

“…Study results from literature demonstrate that this phase is sometimes omitted, such that in these cases the common basis for the decision is not established. 23 In the majority of cases in the present study, information was reported in a neutral manner, whereas other reports included comments or assessments. While Hamilton et al 28 observed that treatment options were expressed in a non-neutral manner to patients and that the framing effect thus influenced decisions, the study noted that healthcare providers frequently also use such a non-neutral form of presentation when reporting to other healthcare providers.…”

“… 22 In another study, also using conversation analysis, 4% of case discussions in MTBs in breast cancer care directly started with the discussion, and in MTBs in gynecological cancer care, in 4% of case discussions the decision was not articulated. 23 …”

Optimising the quality of multidisciplinary team meetings: A narrative review

“…In terms of the MDM decision‐making processes, patient‐centred care was included as a criterion in the guideline by Taylor et al, 13 whilst the guideline by Ottevanger et al 10 had an additional focus on the documentation of decisions made at MDMs. The importance of these guidelines was emphasised by an observational study by Soukup et al noting that more than half the case reviews take place between only two or three disciplines in the meetings 15 …”

“…The importance of these guidelines was emphasised by an observational study by Soukup et al noting that more than half the case reviews take place between only two or three disciplines in the meetings. 15 One study explored the role of streamlining patient discussions as opposed to discussing every patient. 16 The authors defined streamlining discussion as enabling the prioritisation of more complex cases during MDMs over straightforward cases, which can be discussed briefly, or excluded from MDMs altogether.…”