Information Sharing and Case Conference Among the Multidisciplinary Team Improve Patients’ Perceptions of Care

Komatsu, Hiroko; Nakayama, Kazuhiro; Togari, Taisuke; Suzuki, Kumi; Hayashi, Nariyuki; Murakami, Yoshie; Iioka, Yukiko; Osaka, Wakako; Yagasaki, Kaori; Nakamura, Seigo; Neumann, Joyce; Ueno, Naoto T.

doi:10.2174/1874434601105010079

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…Changes in management decisions,[6] surgical choice,[3] patient satisfaction,[24] radiographic/pathologic interpretation,[8] and expedited treatment times,[9] have all been associated with the use of MDC in single-institution studies of breast cancer management. As such, the European Partnership for Action Against Cancer (EPAAC) issued a policy statement in 2014 identifying multidisciplinary teams as a core component of cancer care organizations, and defined the elements necessary for a multidisciplinary approach to cancer care in Europe.…”

Section: Discussionmentioning

confidence: 99%

Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

Churilla

Egleston

Murphy

et al. 2016

Breast Cancer Res Treat

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PURPOSE Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. METHODS Patients diagnosed with non-metastatic invasive breast cancer from 1992–2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist. Same day-MDC (MDCSD) was the MDC subset having all three visits on one date. RESULTS Among 88,865 patients, MDC was utilized in 2.9%, with 12% of these having MDCSD. MDC use did not vary by stage, but MDC patients were more likely to be younger, black, receive lumpectomy, have fewer nodes examined, and receive radiotherapy. MDCSD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDCSD use increased over time and varied by geographic region, with rural patients less likely to receive MDC(OR0.54[95% CI 0.45–0.65]) and MDCSD(OR0.32[95% CI 0.19–0.54]). Radiotherapy after breast conserving surgery, used in 86.2% of non-MDC patients, was administered to 89.0% of MDC(p<0.001) and 92.6% of MDCSD(p=0.096) patients. Post-mastectomy radiotherapy was administered in 52.0% of non-MDC patients, 63.8% of MDC(p=0.050), and 89.1% of MDCSD(p=0.011) after propensity score adjustment. CONCLUSION While increasing, few Medicare patients undergo MDC and MDCSD is rare. MDC may improve quality and MDCSD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDCSD across the U.S.

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Section: Discussionmentioning

confidence: 99%

Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

Churilla

Egleston

Murphy

et al. 2016

Breast Cancer Res Treat

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“…Further complicating assessment of value, one must consider benefits that extend beyond the variables described here and likely beyond what one can quantify: not recorded in our data but noted during MDTB discussion include benefits such as the efficiency of face-to-face communication, opportunity for discussion and possible resolution of conflictual opinions, and enhanced working relationships between physicians, as well as other benefits that have previously been reported including the opportunity to clarify criteria for clinical trials and enroll patients 32 , affirmation of individual physician decision-making after collaborative discussion, and enhanced patient perception of patient-centered care when clinicians discuss the results of MDTB in clinical visits 33 .…”

Section: Discussionmentioning

confidence: 99%

Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study

Brauer

Strand

Sanford

et al. 2017

HPB

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Background & Objectives Multidisciplinary tumor boards (MDTBs) are frequently employed in cancer centers but their value has been debated. We reviewed the decision-making process and resource utilization of our MDTB to assess its utility in the management of pancreatic and upper gastrointestinal tract conditions. Methods A prospectively-collected database was reviewed over a 12-month period. The primary outcome was change in management plan as a result of case discussion. Secondary outcomes included resources required to hold MDTB, survival, and adherence to treatment guidelines. Results 470 cases were reviewed. MDTB resulted in a change in the proposed plan of management in 101 of 402 evaluable cases (25.1%). New plans favored obtaining additional diagnostic workup. No recorded variables were associated with a change in plan. For newly-diagnosed cases of pancreatic ductal adenocarcinoma (n=33), survival time was not impacted by MDTB (p=.154) and adherence to National Comprehensive Cancer Network guidelines was 100%. The estimated cost of physician time per case reviewed was $190. Conclusions Our MDTB influences treatment decisions in a sizeable number of cases with excellent adherence to national guidelines. However, this requires significant time expenditure and may not impact outcomes. Regular assessments of the effectiveness of MDTBs should be undertaken.

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“… 18 On the one side, studies reveal benefits of MTCs for treatment decision-making, 20 and MTCs are accepted and valued by providers and patients. 21 , 22 On the other side, studies show that the patients’ characteristics and perspectives are seldom considered in MTCs 19 , 23 , 24 and recommendations from the MTCs are not always followed by patients and providers. 23 In summary, the idea of MTCs is somewhat representative of the concept of individualized standardization.…”

Section: Individualized Standardization In Multidisciplinary Tumor Comentioning

confidence: 99%

Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution Comment on "(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare"

Ansmann

Pfaff

2017

Int J Health Policy Manag

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In their 2017 article, Mannion and Exworthy provide a thoughtful and theory-based analysis of two parallel trends in modern healthcare systems and their competing and conflicting logics: standardization and customization. This commentary further discusses the challenge of treatment decision-making in times of evidence-based medicine (EBM), shared decision-making and personalized medicine. From the perspective of systems theory, we propose the concept of individualized standardization as a solution to the problem. According to this concept, standardization is conceptualized as a guiding framework leaving room for individualization in the patient physician interaction. The theoretical background is the concept of context management according to systems theory. Moreover, the comment suggests multidisciplinary teams as a possible solution for the integration of standardization and individualization, using the example of multidisciplinary tumor conferences and highlighting its limitations. The comment also supports the authors’ statement of the patient as co-producer and introduces the idea that the competing logics of standardization and individualization are a matter of perspective on macro, meso and micro levels.

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Information Sharing and Case Conference Among the Multidisciplinary Team Improve Patients’ Perceptions of Care

Cited by 14 publications

References 19 publications

Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study

Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution Comment on "(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare"

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