Investigating the system effect of reporting multidisciplinary care measures for cancer services in New South Wales, Australia

Kahren M White,Ru K Kwedza,Reema Harrison,Holly Seale

doi:10.1186/s12913-021-07050-7

Abstract

BackgroundMultidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures.MethodsFocus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset.ResultsTwo focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW.ConclusionsThe findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities.

Highlights

Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally
Four primary themes emerged from the data: harnessing technological advancements; role ambiguity in documentation; clinical relationships within the multidisciplinary team; and linking multidisciplinary teams, funding and performance outcomes
Harnessing technological advancements Most participants reported that in the past 2 years there has been effort by both the Cancer Institute New South Wales (NSW) and cancer services on understanding how the Oncology Medical Information System (OMIS) and other electronic medical records were being used to develop agendas and document the Multidisciplinary team meetingNSWNew South Wales (MDTM) discussion, as well as how they could be further developed for this purpose

Summary

Introduction

Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. The use of MDTMs has been identified as being essential to ensure the provision of evidence based and high quality care to patients as part of these recommendations [2]. Following the systemwide implementation of MDTMs in the United Kingdom from the mid 1990’s the National Breast Cancer Centre in Australia initiated a national multidisciplinary care demonstration project for breast cancer in 1999, to examine the impact, cost and acceptability of implementing multidisciplinary care for women with breast cancer across Australia [3]. Multidisciplinary care and the use of MDTMs provides a systems-level approach to improve adherence to clinical guidelines, as well as improving the team approach to the diagnosis, staging and recommended treatment for people with a cancer diagnosis [7]. MDTMs have a role in clinical governance, ensuring evidence based treatment decisions are made for those patients discussed [7]

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