Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

Abstract

ObjectivesGiven the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient.DesignA sequential mixed-method study.SettingOne oncology centre and its partner in the Northern part of the Netherlands.ParticipantsHead-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner.Primary and secondary outcome measuresPercentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT.ResultsIn eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fresh perspective by hearing the case ‘as new’. The teams recognise the importance of keeping their medical viewpoints aligned, but the requirement (that the partner should discuss all patients) was seen as outdated.ConclusionsThe added value of the video-conferenced MDT is small considering patient care, but the specialists recognised that it is important to keep their medical viewpoints aligned and that their patients benefit from the discussions on complex cases.

Benefits and drawbacks of videoconferencing for collaborating multidisciplinary teams in regional oncology networks: a scoping review

“…Six types of team collaboration in oncology care were distinguished (table 1): (1) Expert MDTM-national: provides expertise and experience on rare tumours nationally (17 studies) 18-34 ; (2) Expert MDTM-International: provides international expertise and experience on rare tumours (5 studies) [35][36][37][38][39] ; (3) Expert Consultation: physicians caring for complex patients seeking a consultation with experts (11 studies) [40][41][42][43][44][45][46][47][48][49][50] ; (4) Consultation Specialist-Nurse: nurses consulting with palliative treatment specialists in specialised palliative care units or hospices (4 studies) [51][52][53][54] ; (5) MDT-Equal: involving more or less equal MDTs that use each other for a 'fresh look' to optimise the diagnostic and treatment plans for complex cases (5 studies) [55][56][57][58][59] ; and (6) MDTM-Collaborate: MDTs collaborating to form one MDTM (8 studies) [60][61][62][63][64][65][66][67] (online supplemental file 5).…”

“…VC enhanced multidisciplinary discussions between specialists and other healthcare professionals on diagnostic and treatment plans in all 13 studies where this was investigated. [55][56][57][58][59][60][61][62][63][64][65][66][67] VC strengthened their collegial networks or established new partnerships, resulting in virtual management of regional oncology networks. In this way, VC facilitated collegial support and reduced professional isolation.…”

“…Using VC between equal teams led to optimised diagnostic or treatment plans for complex cases and provided easy access to second opinions (5 studies). [55][56][57][58][59] Recommendations given during VC to treatment plans resulted in less correspondence between MDT members (3 studies). 56 58 59 VC was also used for aligning protocols, with peer review principles being used to stimulate working according to oncology guidelines (2 studies).…”

Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation

“…Another observation was the improvement in case coordination due to the more complete presence of required disciplines during the MDTM and the better relationships. Although the importance of improved case coordination between healthcare professionals with better interpersonal relationships has also been found previously [49,50,51,52], more research is needed to understand the underlying processes and the way it adds value to a care pathway.…”

Virtual Clinical and Precision Medicine Tumor Boards—Cloud-Based Platform–Mediated Implementation of Multidisciplinary Reviews Among Oncology Centers in the COVID-19 Era: Protocol for an Observational Study

“…More recently, technological advances have made collaboration between MTB members easier by introducing the possibility of “virtual” meetings when team members are not available in person [ 19 , 20 ]. Even if in recent years, the medical/scientific community has rightly focused on the realization of MTB, with the widespread perception that teamwork has brought benefits to patients and improved decision-making, it is necessary to focus on how MTBs function and how they will have to evolve in light of the epochal changes that SARS-CoV-2 induces in the short, medium, and long terms.…”