Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology

Abstract

Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.

Multidisziplinäre Tumorkonferenzen in Deutschland

“…Ein zentraler Aspekt bei der Umsetzung von Therapieempfehlungen basierend auf MTK-Entscheidungen ("Tumorboard-Adhärenz") ist die teils fehlende Berücksichtigung des Patientenwunsches (Baes et al 2020;Basta et al 2017;Gruber 2012;Hollunder et al 2018). Dies kann beispielsweise durch die Einbindung von Pflegepersonal (Knötgen 2020;Rosell et al 2018) oder die Teilnahme von Patientinnen und Patienten an MTK (Diekmann et al 2020;Heuser et al 2019;Bate et al 2019;Hahlweg et al 2015) erreicht werden.…”

Exploring non-physician care professionals’ roles in cancer multidisciplinary team meetings: A qualitative study

“…Treatment decision-making is, however, still considered to be a solely medical task [ 28 ]. Medical professionals themselves define the particular aim of an MDTM as purely clinical, i.e.…”

The Next Step Toward Patient-Centeredness in Multidisciplinary Cancer Team Meetings: An Interview Study with Professionals

“… 13 , 25 Third, time pressure at MDT meetings can rush decision-making. 5 , 10 , 13 , 26 This affects the quality of the decision-making, due to reduced task-oriented communication and reduced socio-emotional interactions between MDT members. 27 , 28 Fourth, although MDT members may have an open attitude towards psychosocial aspects and patient preferences, they may perceive several regulatory or organizational restraints.…”

“… 27 , 28 Fourth, although MDT members may have an open attitude towards psychosocial aspects and patient preferences, they may perceive several regulatory or organizational restraints. 26 Finally, in most cases, only a single treatment option is communicated to the patient, although a broader spectrum of possible treatment options has been discussed. 13 These barriers may hinder the successful implementation of strategies to improve patient-centeredness.…”