What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector

Abstract

IntroductionAn understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings.Methods and analysisA suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings.Ethics and disseminationEthical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings

“…Data were managed in accordance with ethical practice, as previously reported [ 41 ]. Reviewed documents were used to generate profiles of each site, to inform data collection and to contextualise observational and interview data.…”

Virtual Clinical and Precision Medicine Tumor Boards—Cloud-Based Platform–Mediated Implementation of Multidisciplinary Reviews Among Oncology Centers in the COVID-19 Era: Protocol for an Observational Study

“…Despite medical literature reporting that the concept of a multidisciplinary approach to cancer treatment since 1975, MTBs in real clinical practice started in the late 1990s. From that point on, the multidisciplinary approach has continually increased, becoming a milestone in many cancer centers and a key moment in treatment plans and guidelines [ 13 ]. Over time, MTBs have evolved into a more collaborative structure with teams that pay attention to all aspects of cancer care, including rehabilitation, nutrition, psychosocial needs, and long-term care [ 12 - 16 ].…”

“…Such teams currently exist for some cancers in some hospitals, but this is not the rule. Moreover, the increasing complexity of clinical pathways require a stronger interaction between high-volume centers and low-volume and community centers [ 13 ]. Before the creation of MTBs, patient evaluations were often carried out, and the oncological treatments often provided, by specialists without all the necessary knowledge and skills related to a specific tumor in terms of continuous training and adherence to local, national, and international guidelines [ 8 , 17 ].…”

Providing outpatient cancer care for CALD patients: a qualitative study

“…We conducted a multi-centre study which characterised the organisation and practice of care in outpatient clinics (OPCs) and identified the barriers to, and facilitators of its provision. This paper reports the CALD-relevant data collected as part of that study [ 25 ].…”