Multi-Disciplinary Team (MDT) Approach in Oral Cancer Management: An Exploratory Study

Abstract

Background: Treatment of oral cancer has evolved throughout the past decades which has led to the introduction of the multi-disciplinary team approach (MDT). The MDT concept has been endorsed as the main approach to ensure holistic care for oral cancer patients worldwide. In Malaysia, the MDT concept has been introduced in few hospitals throughout the country. According to the available literature, the MDT approach has improved coordination of care for oral cancer patients, communication between the different disciplines, decision making to obtain the best treatment plan, provided educational opportunities for development of the members, and improved staff and patient well-being. However, little evidence is available to support the fact that the MDT approach has improved patient survival and outcome. Aim: The aim of this study was to explore the MDT approach in the management of oral cancer patients. To our knowledge this is the first study on head and neck MDTs in Malaysia. Methods: The study was conducted at University of Malaya. A mixed-method study was commenced including both quantitative and qualitative designs. The quantitative part assessed the MDT members' attitude toward the role and use of the MDT approach in oral cancer patient management, while the qualitative part assessed the perception of the MDT members regarding the MDT approach in terms of: team structure, team process, decision making, barriers and suggestions for improvement of the MDT approach. The quantitative study was conducted through a structured self-administered questionnaire which were both content and face validated, and distributed to the members of the head and neck MDT. The qualitative study was commenced through two focus group discussions (FGDs) conducted separately. Results: The study was conducted among the head and neck MDT members at University Malaya which received a 100% response rate. The majority of the MDT members showed positive attitudes toward the MDT approach, with the seniors being more positive than the juniors. The MDT approach has improved team dynamics in terms of communication, care coordination and decision making. However, there were a few issues of miscommunication as well as long waiting lists for oncological radiotherapy machines and radiologic scanning. Conclusion: The MDT approach is certainly the preferable mode of care for oral cancer patients in University of Malaya. However, there is a need for further improvement with regards to communication between the team members, expansion of the current team composition, training of the MDT members with regards to clinical and nonclinical skills, guidelines, protocols and certain facilities. Teamwork is a fundamental perspective which is crucial for an effective MDT. As such, a better understanding of each other's roles and responsibilities within the team is essential to ensure optimum patient care and management.