Do multidisciplinary cancer care teams suffer decision-making fatigue: an observational, longitudinal team improvement study

Abstract

ObjectiveThe objective of this study was to examine effectiveness of codesigned quality-improving interventions with a multidisciplinary team (MDT) with high workload and prolonged meetings to ascertain: (1) presence and impact of decision-making (DM) fatigue on team performance in the weekly MDT meeting and (2) impact of a short meeting break as a countermeasure of DM fatigue.Design and interventionsThis is a longitudinal multiphase study with a codesigned intervention bundle assessed within team audit and feedback cycles. The interventions comprised short meeting breaks, as well as change of room layout and appointing a meeting chair.Setting and participantsA breast cancer MDT with 15 members was recruited between 2013 and 2015 from a teaching hospital of the London (UK) metropolitan area.MeasuresA validated observational tool (Metric for the Observation of Decision-making) was used by trained raters to assess quality of DM during 1335 patient reviews. The tool scores quality of information and team contributions to reviews by individual disciplines (Likert-based scores), which represent our two primary outcome measures.ResultsData were analysed using multivariate analysis of variance. DM fatigue was present in the MDT meetings: quality of information (M=16.36 to M=15.10) and contribution scores (M=27.67 to M=21.52) declined from first to second half of meetings at baseline. Of the improvement bundle, we found breaks reduced the effect of fatigue: following introduction of breaks (but not other interventions) information quality remained stable between first and second half of meetings (M=16.00 to M=15.94), and contributions to team DM improved overall (M=17.66 to M=19.85).ConclusionQuality of cancer team DM is affected by fatigue due to sequential case review over often prolonged periods of time. This detrimental effect can be reversed by introducing a break in the middle of the meeting. The study offers a methodology based on ‘team audit and feedback’ principle for codesigning interventions to improve teamwork in cancer care.

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

“…Building of such an evidence-base would be uniquely useful: it would allow assessment of MDT decision-making fidelity in the context of their weekly meetings in a structured manner according to the individual stages, while “diagnosing” what element(s) of this process require attention, and facilitating improvement through team feedback. 19 In turn, such knowledge would contribute to accurate interpretation of team outcomes, enhancing understanding of how MDT-driven care planning works in practice, and aid identification of MDT needs and aspects of their delivery requiring improvement.…”

<p>Health Professionals’ Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study</p>

“…1 At the same time, MDTMs are resource-demanding with a growing number of case discussions and increasingly complex diagnostic paths and treatment options, which raises consideration of resource-effectiveness, possibilities to prioritize case discussions and risk of decision-making fatigue. 2,3 These dual perspectives motivates evaluation of health professionals' experiences from MDTMs.…”

Relationships Between Communication, Time Pressure, Workload, Task Complexity, Logistical Issues and Group Composition in Transdisciplinary Teams: A Prospective Observational Study Across 822 Cancer Cases

“…In light of such pressures, safety concerns have also been raised, as sometimes dozens of patients have been reported to be discussed in one sitting by a MDT (Cancer Research UK, 2017). The evidence from studies of cancer MDMs suggests that the prolonged reviewing of sequential cases has a negative impact on the quality of treatment recommendations for patients; better quality decisions were associated with discussing patients at the beginning of the meeting (Lamb et al, 2013;Soukup et al, 2019aSoukup et al, ,b, 2020a.…”