Quality of Care Management Decisions by Multidisciplinary Cancer Teams: A Systematic Review

Abstract

Team/social factors affect management decisions by cancer MDTs. Inclusion of time to prepare for MDTs into team-members' job plans, making team and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings. These improvements ought to be considered at national policy level, with the ultimate aim of improving cancer care.

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study

“…The past decade has seen developments in research on MTBs, with studies examining the team decision-making process, decision implementation, and patient participation. A recurring pattern in decision-making is the skewed contribution to case reviews towards physicians and the biomedical aspect of the disease, at the expense of nursing input (even where specialist nurses are formally in attendance), patients' comorbidities and psychosocial circumstances [7][8][9]. The general consensus, however, is that patient-centered, holistic clinical decisions underpin high-quality patient care [3,8,[10][11].…”

“…A recurring pattern in decision-making is the skewed contribution to case reviews towards physicians and the biomedical aspect of the disease, at the expense of nursing input (even where specialist nurses are formally in attendance), patients' comorbidities and psychosocial circumstances [7][8][9]. The general consensus, however, is that patient-centered, holistic clinical decisions underpin high-quality patient care [3,8,[10][11]. There is evidence that failure to account for patients' social circumstances [12] and comorbidities [9] has a negative impact on the ability of MTB's to implement treatment recommendations [12].…”

Multidisciplinary clinical approach to the management of head and neck cancer

“…The benefits of MDT working are thought to include improved communication, coordination, and decision-making between health care team members when weighing up treatment options. Indeed, multidisciplinary discussion can help health care professionals to tailor holistic treatment plans to patients' tumour types, biological markers as well as their comorbidities and social circumstances [7]. Evidence has been provided that multidisciplinary team-working can make a positive impact on the quality of clinical decision-making, clinical outcomes for patients, patients' experience of care and also the impact on the working lives of team members [8].…”

“…In summary, the analysis of the survey reveals a strong consensus between MDT members from different tumour types, while also identifying areas that require a more tailored approach, such as the clinical decision-making process, and preparation for and organisation of MDT meetings [5]. In addition, in a systematic review on factors that affect the quality of clinical decision-making of MDTs, several factors have been identified: inclusion of time to prepare for MDTs into team-members' job plans, making teams and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings [7,12].…”

“…Ultimately, clinical outcome should be included when assessing MDT performance, but short-term outcome and potentially process measures (such as time from first referral to diagnosis, time from diagnosis to the first treatment, and cost reductions) should also be developed. There is evidence that the ability of an MDT to reach a decision on the first-case presentation and ability of MDT decisions to be implemented appear to be useful markers of the performance of the MDT [7]. Moreover, outcomes such as patient's satisfaction and health care professional satisfaction are also increasingly seen as important measures of the effectiveness of health care [50,51].…”