The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

Abstract

Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians [PCPs], and support services) (1). Earlier in this supplement, Taplin and others have pointed out the challenges of transferring information and responsibility among providers and institutions; a problem at the interfaces of care. Advances in surgical procedures, chemotherapy, computer technology, and targeted molecular and radiation therapies have all led to an increase in multimodality therapy, which increases the number of interfaces among cancer specialists and other clinicians in the treatment of any single patient. Contemporary cancer care thus presents a paradox: The potential for unparalleled quality and sophisticated treatment is high, yet the number of potential "failure" events in the continuum of cancer treatment (2) has multiplied significantly. Each failure in communication between various physicians and care providers and every transition and interface miscue can result in delayed treatment planning and implementation, unnecessary duplication of tests, incomplete follow-up, increased patient anxiety, decreased patient satisfaction, and declines in quality of life.This article will examine a particular type of organizational structure focused on the interfaces between multiple specialists involved in cancer treatment: the multidisciplinary treatment care (MDC) team. This structure has been identified as one method of ensuring the exchange of patient-related and technical information between all physicians and support services involved in a patient's care. The setting and format of the MDC encourage active involvement of all actors (including the patient and his/her family) in the development of a care plan. Once formed, MDC team meetings can be convened at multiple times throughout the process of cancer care (Figure 1 in Taplin) (3) and can thus serve as an ongoing communication structure aimed at smoothing the transitions between multiple stages of care.MDC teams are the successors to the tumor conference, and they have been an arrangement for coordinating cancer care for at least 30 years (4,5). The health-care management literature advocates for more frequent use of MDC teams (6,7), and the National Cancer Institute has historically supported their development and diffusion, dating back to the cancer network demonstrations of the late 1970s and early 1980s (5,8), and through the National Cancer Institute Community Cancer Center Programs of recent times (9). However, little, if any empirical evidence exists on the prevalence, efficacy, and diffusion of MDC teams in cancer treatment or on their effectiveness in smoothing transitions across stages of cancer care.This article presents a targeted review of the literature (primarily since 2000) on what is known about various types of MDC ...

Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary and Oncology-Related Subspecialty Care

“…These two articles by Anhang Price et al (29) and Zapka et al (30) reinforce the idea that interventions to address interfaces will need to consider the multiple levels of the care context to achieve improvements. The next article, by Fennell et al (31), considers cancer treatment and examines how one common approach, the multidisciplinary care team, has evolved to affect the interfaces of care. Murray et al (32) then discuss the range of study designs that can be used to test changes in these influences, whereas Hade et al (33) report intraclass correlations in measures relevant to the multilevel intervention studies.…”

The History and Physical in Cancer Care: A Primer for the Oncology Advanced Practitioner

“…For outpatients or planned inpatient admissions, the gathering of background information is ideally performed prior to the visit in the event that the search for this information is particularly time consuming or complicated. Having a sense of the patient complexity, eligibility for clinical trials, possible comorbidities, educational requirements, and need for psychosocial support is also helpful for daily resource (time, clinical staff ) planning for both the AP and other collaborative cancer care professionals (Fennell et al, 2010). Each tumor type will have specific criteria for what is needed for treatment decisions to be made.…”

“…If possible, it is helpful to discuss the likely treatment with the physician prior to seeing the patient so the cancer care team portrays itself as consistent and able to communicate among its members (Fennell et al, 2010). That is important because the history will then be focused on determining the likelihood that this specific patient can physically and emotionally withstand the projected therapy.…”

“…In order to be a wellintegrated member of the cancer care treatment team, the AP must understand the components of the new patient visit and the complex staging process that is necessary to determine the appropriate treatment and fully understand the likely disease course. Additionally, in prospectively assessing the complexities of each patient, the tumor characteristics, and the likely therapy, the AP can begin to involve the other health-care professionals from the cancer care team to facilitate a multidisciplinary, holistic plan of care (Fennell, Das, Clauser, Petrelli, & Salner, 2010).…”

Multidisciplinary clinical approach to the management of head and neck cancer

“…An additional aspiration was to ensure seamless specialist continuity of care for all patients, as well as the offer of adequate information and support. There is almost universal approval for this strategy [9], which indeed some considers crucial [10], despite the fact that there is little evidence of its effectiveness in improving outcomes [11]. A large survey [5] of MDT members in the UK in 2009, and included 109 from the Head and Neck Service, enabled a set of recommendations to be formulated to define how an effective MDT would work (http://www.ncat.nhs.uk).…”