Implementing a clinical cutting-edge and decision-making activity: an ethnographic teamwork approach to a molecular tumorboard

Nathalie Bot,Mathias Waelli

doi:10.1186/s12913-020-05786-2

Abstract

BackgroundNew technology implementation in healthcare must address important challenges such as interdisciplinary approaches. In oncology, molecular tumorboard (MTB) settings require biomedical researchers and clinical practitioners to collaborate and work together. While acknowledging that MTBs have been primarily investigated from a clinical rather than an organizational perspective, this article analyzes team processes and dynamics in a newly implemented MTB.MethodsA systemic case study of a newly implemented MTB in a Swiss teaching hospital was conducted between July 2017 and February 2018, with in situ work observations, six exploratory interviews and six semi-structured interviews.ResultsAn MTB workflow is progressively stabilized in four steps: 1) patient case submissions, 2) molecular analyses and results validation, 3) co-elaboration of therapeutic proposals, and 4) reporting during formal MTB sessions. The elaboration of a therapeutic proposal requires a framework for discussion that departs from the formality of institutional relationships, which was gradually incepted in this MTB.ConclusionsFirstly, our research showed that an MTB organizational process requires the five teaming components that characterizes a learning organization. It showed that at the organizational level, procedures can be stabilized without limiting practice flexibility. Secondly, this research highlighted the importance of non-clinical outcomes from an MTB, e.g. an important support network for the oncologist community.

Highlights

New technology implementation in healthcare must address important challenges such as interdisciplinary approaches
Our literature review showed that molecular tumorboard (MTB) were diverse, ranging from small advisory boards providing treatment recommendations, to boards incorporated into large precision oncology-based clinical trials; all differed in composition, expert categories, genomic areas, bioinformatics techniques and workflows [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]
The main challenges underlying the cutting-edge clinical decision-making process, is the construction of off-label scenarios for patients, where beneficial treatment actions for unusual cancers and/or genomic alterations are identified and reasonably predicted. This model results from a long process; presented in two parts; the first describes four workflow organizational steps, starting with the referring oncologist request, through to the therapeutic proposal presented at MTB sessions

Summary

Introduction

Molecular tumorboard (MTB) settings require biomedical researchers and clinical practitioners to collaborate and work together. In particular the field of precision oncology, new technologies are redesigning work organizations. The advent of targeted therapies, including the identification of genetic mutations active in cancer, i.e. driver mutations, and the development of affordable high throughput sequencing technologies, has opened up the field of precision oncology [1,2,3]. In this respect, sequencing platforms in university hospitals have gradually resorted to predictive oncology approaches, and organizing their activities around multidisciplinary Molecular Tumorboards (MTB) [5]. What is key to these MTBs is not the coordination of care as in conventional tumorboards, but the interpretation of tumor molecular profiles that underpin treatment recommendations. Our literature review showed that MTBs were diverse, ranging from small advisory boards providing treatment recommendations, to boards incorporated into large precision oncology-based clinical trials; all differed in composition, expert categories, genomic areas, bioinformatics techniques and workflows [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]

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