Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

Léa Restivo,Thémis Apostolidis,Anne-Déborah Bouhnik,Thérèse Aurran,Sylvain Garciaz,Claire Julian-Reynier,Wendy Wing Tak Lam

doi:10.1371/journal.pone.0154969

Abstract

BackgroundThe contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions.DesignObservations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed.ResultsIn the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available.LimitationsThe design of the study made it difficult to draw definite cause-and-effect conclusions.ConclusionThe Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians’ everyday professional practice. The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

Highlights

The image of a neutral physician or health care provider taking medical decisions on the sole basis of patients’ medical characteristics has long been challenged in the field of social science [1]
The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind
In line with the Social Representations approach, which takes patient’s non-medical characteristics to be a kind of knowledge which gives people the feeling of mastering the situation, we focused here on Multidisciplinary Team (MDT) meetings dealing with non-standard case records involving a high level of uncertainty, at which non-medical information was likely to crop up fairly frequently

Summary

Introduction

The image of a neutral physician or health care provider taking medical decisions on the sole basis of patients’ medical characteristics has long been challenged in the field of social science [1]. Mostly in the field of painful disorders, have provided evidence that nonmedical factors are usually involved in medical professionals’ everyday practice [2, 3, 4] Among these non-medical aspects, patients’ social characteristics such as their age, gender and social class have been found to account for the variability of physicians’ decisions [5, 6]. When scientific data are lacking and medical decision-making cannot be evidence-based, decision-making can be based on either professional guidelines of other kinds or physicians’ own clinical experience of specific cases This is what happens when dealing with advanced cases of cancer, for example [11]. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions

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