Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: An interview study of the provider perspective

Jalil, Rozh; Ahmed, Maria; Green, James S. A.; Sevdalis, Nick

doi:10.1016/j.ijsu.2013.02.026

Cited by 110 publications

(148 citation statements)

References 38 publications

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“…[7–8] Moreover, multidisciplinary team (MDT) members highlighted the importance of having a complete patient profile, as well as all participating disciplines in attendance, for effective decision-making. [9] Improving MDT working therefore is complex although highly important with the cancer incidence and costs of care being predicted to rise, [10–11] whereas the significant financial pressures on the healthcare remain. [12] …”

Section: Introductionmentioning

confidence: 99%

The anatomy of clinical decision-making in multidisciplinary cancer meetings

et al. 2016

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In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable.The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision.This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons.We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis.The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001).Hawthorne effect is the main limitation of the study.The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core disciplines. Evidence of dual-task interference was observed in relation to the meeting chairs’ input and their corresponding surgical input into case reviews.

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Section: Introductionmentioning

confidence: 99%

The anatomy of clinical decision-making in multidisciplinary cancer meetings

et al. 2016

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“…The members considered the most important factors for effective MDT working to be those shown in table 2. A qualitative study of urological and gastrointestinal MDT members supports these findings citing nonattendance of key members at meetings, inadequate clinical information and technological failures as barriers to clinical decision making [54].…”

Section: Barriers To Effective Mdt Workingmentioning

confidence: 84%

“…Retrospective analyses have found that between 4% and 16% of MDT treatment plans were not actually implemented [11,53], and this may cause delays because of the need to refer to a different specialist [42]. The reasons that MDT recommendations were not implemented were usually patient choice or deterioration in fitness [11,53,54]; however, it is possible that last-minute cancellations of procedures or clinic appointments may affect the services available for other patients.…”

Section: Potential Problems With Mdt Managementmentioning

confidence: 99%

Multidisciplinary team management in thoracic oncology: more than just a concept?

Powell

Baldwin

2014

Eur Respir J

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Multidisciplinary team (MDT) management in thoracic oncology has been introduced over the past two decades with the aim of improving outcomes for patients. While MDT management has become the standard of care in some countries, not all healthcare systems have adopted this practice. In this article we review the history and implementation of MDT care in thoracic oncology and explore the evidence for, and challenges associated with, this system of working.There are many advantages of an MDT both to the patient, the clinicians and the wider population, but it is difficult to demonstrate a beneficial effect on outcomes such as treatment rates or survival given the substantial number of coexistent changes in the management of thoracic malignancies over the same time period. There are also some disadvantages associated with MDT working, particularly the costs of setting up the service and the time commitment from each of the healthcare professionals involved. Barriers to effective MDT working include poor attendance by some specialists, inadequate preparation and poor quality information about the patient. Variation in quality of MDTs has been reported so it is important that practice is monitored and areas for improvement identified. @ERSpublications Multidisciplinary teams ensure patients receive timely specialist input but effect on treatment/ survival is hard to show

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“…The respective experts were also viewed as core members of the IBD MDT (figure 2). Non-attendance of key members is a barrier to effective decision-making in the IBD MDT setting 24 25. Recommendations made by the participants to ensure attendance included making the IBD MDT part of the job plan and ensuring that it is protected time.…”

Section: Discussionmentioning

confidence: 99%

Defining the optimal design of the inflammatory bowel disease multidisciplinary team: results from a multicentre qualitative expert-based study

Morar

Read

Arora

et al. 2015

Frontline Gastroenterol

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ObjectiveTo elicit expert views to define the aims, optimal design, format and function of an inflammatory bowel disease (IBD) multidisciplinary team (MDT) with the overall purpose of enhancing the quality of MDT-driven care within an IBD service provision.DesignThis study was a multicentre, prospective, qualitative study using a standard semistructured interview methodology.ParticipantsA multidisciplinary sample of 28 semistructured interviews of which there are six consultant colorectal surgeons, six IBD nurse specialists, seven consultant gastroenterologists, five consultant radiologists and four consultant histopathologists.SettingParticipants were recruited from 10 hospitals, which were a mixture of community hospitals and specialist IBD centres between June and October 2013.ResultsExperts argued that the main goal of MDT-driven IBD care is to improve patient outcomes via sharing collective expertise in a formalised manner. Themes regarding the necessary requirements for an IBD MDT to occur included good attendance, proactive contribution, a need to define core members and appropriate and functional computer facilities. Emergent themes regarding the logistics of an effective IBD MDT included an eligibility criterion for case selection and discussion and appropriate scheduling. Themes regarding the overall design of the IBD MDT included a ‘hub-and-spoke’ model versus a ‘single-centre’ model.ConclusionsDefining key elements for an optimal design format for the IBD MDT is necessary to ensure quality of care and reduce variation in care standards. This study has produced a set of expert-based standards that can be used to structure the IBD MDT. These standards now require larger scale validation and consensus prior to becoming a practical guideline for the management of IBD care.

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Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: An interview study of the provider perspective

Cited by 110 publications

References 38 publications

The anatomy of clinical decision-making in multidisciplinary cancer meetings

The anatomy of clinical decision-making in multidisciplinary cancer meetings

Multidisciplinary team management in thoracic oncology: more than just a concept?

Defining the optimal design of the inflammatory bowel disease multidisciplinary team: results from a multicentre qualitative expert-based study

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