Multidisciplinary cancer care in Australia: A national audit highlights gaps in care and medico‐legal risk for clinicians

Abstract

MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided.

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

“…MDT membership and attendance at meetings varied according to hospital size and medical specialty. Other important predictors were cancer type, format of the delivery setting, and perceived efficiency of the meeting performance [45,[50][51][52]62]. Several papers differentiated team composition by identifying three levels of involvement, i.e., "core", "allied" (or "extended") and "expert support" membership.…”

“…Several papers differentiated team composition by identifying three levels of involvement, i.e., "core", "allied" (or "extended") and "expert support" membership. Core and allied members included radiologists, pathologists, surgeons, radiation and medical oncologists, oncology nurses, palliative care physicians, head and neck specialists, nuclear medicine specialists, respiratory disease physicians, gastrointestinal disease physicians and anaesthesiologists, some of whom were frequently sub-specialised by tumour site [20,29,30,[32][33][34]42,43,45,52,53]. The support members included psychologists, nutritionists, dieticians, plastic surgeons, speech therapists, patients' GPs, physiotherapists, practitioners of complementary medicine, orthopaedic specialists, medical physicists, odontologists, faith counsellors, biologists, data managers, genetic counsellors, hospital pharmacists, social workers and occupational therapists [24,27,40,45,49,54,55].…”

“…The different scopes of coordination and the need to adapt to particular practice contexts implied the problem of finding 'equivalents' of the role and defining consistent profiles. Nonetheless, an analysis of the studies allowed the differentiation between 'inward' responsibilities (MDT organisation and efficient direction) and Harrison [45] Lanceley [46] Soukop [47] Choy [48] Chirgwin [49] Scher [ Wilcoxon [52] Magnani [53] Hudak [54] Wiederholt [55] Maslin-Prothero [56] Kuroki [57] Sweeney [58] Brennan [60] Jefford [61] Hong [62] Jones [63] Bellardita [64] Mandate adapted from Wright et al [12] 'outward' responsibilities (clinical management of the care plan). Whereas inward responsibilities consisted of scheduling agendas for meetings, drawing up the list of patients to be discussed, ensuring that all necessary tests were obtained and available in advance of the discussion, and recording the MDT decisions and rationales agreed [34,38,42,45,46], outward tasks entailed communicating decisions to patients/families, GPs, providers and referring physicians, as well as coordinating outpatient visits and referrals from satellite centres, and facilitating the link to research either directly or by improving liaison with the clinical trial coordinator [24,32,34,38,42,43,53,54].…”

“…The decision to overcome logistics-related barriers through the medium of online video-conferences and the use of IT to share radiology and histopathology images, were also described and examined. Finally, the need to support MDTs' clerical and general administrative activity was highlighted [18,30,32,34,42,45,50,52].…”

“…Indeed, some expressly mentioned that the MDT rationale had been explained to the patient [23,24]. Treatment, toxicities, side effects, complications and information on second-and third-line treatments after recurrent disease were variously reported as having been discussed with patients before making decisions, sometimes by using written materials or by providing access to psychologists or social workers [18,20,23,38,42,52,53,56,58,59,61,64]. A number of papers identified the need to take into account patients' physical and psychological comorbidities when making clinical decisions; furthermore, they noted that special attention should be paid to provide the same clinical message and bridging gaps between teams and patients, as well as clearly setting out how to deal with the complexities of the health care system [43,44,53,54,56,60,63].…”