PS5-11-05: Multidisciplinary Team Decision-Making in Breast Cancer: Real-World Insights from the PRISMA Study

BackgroundMultidisciplinary cancer team meetings are intended to optimize the diagnosis of a patient with a malignancy. The aim of this study was to assess the number of correct diagnoses formulated by the multidisciplinary team (MDT) and whether MDT decisions were implemented.MethodsIn a prospective study, data of consecutive patients discussed at gastrointestinal oncology MDT meetings were studied, and MDT diagnoses were validated with pathology or follow-up. Factors of influence on the correct diagnosis were identified by use of a Poisson regression model. Electronic patient records were used to assess whether MDT decisions were implemented, and reasons to deviate from these decisions were hand-searched within these records.ResultsIn 74 MDT meetings, 551 patients were discussed a total of 691 times. The MDTs formulated a correct diagnosis for 515/551 patients (93.4 %), and for 120/551 (21.8 %) patients the MDT changed the referral diagnosis. Of the MDT diagnoses, 451/515 (87.6 %) were validated with pathology. Patients presented to the MDT by their treating physician were 20 % more likely to receive a correct diagnosis [relative risk (RR) 1.2, 95 % confidence interval (CI) 1.1–1.5], while the number of patients discussed or the duration of the meeting had no influence on this (RR 1.0, 95 % CI 0.99–1.0; RR 1.0, 95 % CI 0.9–1.1; resp.). MDT decisions were implemented in 94.4 % of cases. Deviations of MDT decisions occurred when a patient’s wishes or physical condition were not taken into account.ConclusionsMDTs rectify 20 % of the referral diagnoses. The presence of the treating physician is the most important factor to ensure a correct diagnosis and adherence to the treatment plan.

Using guideline-based clinical decision support in oncological multidisciplinary team meetings: A prospective, multicenter concordance study.

Preoperative multidisciplinary team (MDT) meetings are recommended for patients at high risk for perioperative complications and mortality, although the underlying evidence is scarce. We aimed to investigate the effect of MDT decisions on patient management and patient outcome. We conducted a single-centre retrospective cohort study including all noncardiac surgical patients selected for discussion at preoperative MDT meetings from January 2017 to December 2019 (N = 120). We abstracted preoperative data, MDT decisions, and patient outcomes from the electronic health records for analysis. Of the 120 patients registered for an MDT meeting, 43% did not undergo their initially planned surgery. Only 27% of patients received perioperative management as planned before the MDT meeting. Most surgery cancellations were the MDT's decision (22%) or the patient's decision before or after the MDT discussion (10%). Postoperative complications occurred in 28% of operated patients, and postoperative mortality was 4% at 30 days and 10% at three months, most of which was attributable to postoperative complications. Non-operated patients had a 7% mortality rate at 30 days and 9% at three months. Alterations of perioperative management following MDT discussion were associated with fewer cases of extended length of hospital stay (> ten days). This study shows that preoperative MDT meetings for high-risk noncardiac surgical patients altered the management of most patients. Management alterations were associated with fewer hospital admissions of long duration. These results should be interpreted with appropriate caution given the methodological limitations inherent to this small study.

Collective Wisdom and Multidisciplinary Tumor Boards

BackgroundPatient-centeredness is essential in complex oncological multidisciplinary team decision-making. Improvement seems to be needed, while there is a lack of knowledge about health care providers’ needs for improvement.ObjectiveTo explore multidisciplinary team members’ perspectives on the need to improve patient-centeredness in complex decision-making, and subsequently the strategies to enhance it.MethodsThis was a qualitative descriptive interview study. The participants were twenty-four professionals who attended multidisciplinary cancer team meetings weekly. The setting was five multidisciplinary teams (gastrointestinal, gynecological, urological, head and neck, and hematological cancer) in a Dutch academic hospital. Data were collected by semi-structured interviews and were analyzed with a combination of inductive and deductive content analysis.ResultsThe participants voiced the need for additional information (patient-centered information, patients’s needs and preferences, individualized medical information) during the multidisciplinary team meeting, to be more patient-centered in the decision-making conversation with the patient following the meeting, and for more information following the meeting to support patient-centeredness. The strategies, which mostly originated from the needs, were categorized as organization, decision-making, and communication. The most prominent strategies were those aimed at collecting and using patient-centered information, and to facilitate the decision-making conversation with the patient following the multidisciplinary team meeting.ConclusionOur findings highlighted the need to improve patient-centeredness in oncological multidisciplinary teams and provided a comprehensive overview of strategies for improvement, supported by multidisciplinary team members. These strategies emphasize involvement of patients throughout the continuous process of decision-making for patients with cancer. These strategies may be implemented in other oncological multidisciplinary teams, taking in mind the local needs. Future research may help to prioritize the strategies and to determine and evaluate the effect on endpoints, like patient or professional satisfaction, shared decision-making, and on the decision that was made.

Background:Multidisciplinary team (MDT) meetings are considered a component of gold-standard care for patients with spondyloarthritis (SpA) and concomitant psoriasis (PsO) or inflammatory bowel disease (IBD). There are few published reports...

ObjectiveTo critically examine the process of multidisciplinary team (MDT) decision-making with a particular focus on patient involvement.DesignEthnographic study using direct non-participant observation of 35 MDT meetings and 37 MDT clinics,...

Background:A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit.Methods:All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant.Results:Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered ‘unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered ‘justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5).Conclusion:The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were ‘unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.

PurposeThis assesses the current workings of multidisciplinary team (MDT) meetings across Korea through surgeons' reports and their current commitments to MDT meetings pertaining to breast cancer, and to determine any perceived areas of potential improvement.MethodsA questionnaire was sent out to 307 members of The Korean Breast Cancer Society (KBCS) who worked at comprehensive or university medical centers in Korea. The mailing lists of the KBCS members were obtained with the approval of the society. From December 2008 to February 2009, the survey was distributed by surface and electronic mail, with an initial mailing followed by another distribution to non-responders eight weeks later.ResultsSixty-five individuals (21.2%) returned the completed survey. Of these, 38 responders (62.3%) participated in MDT meetings. Most (97.4%) breast health specialists regarded MDT meetings as an effective method for treatment planning. Most responders (94.7%) reported that the MDT leader was a breast surgeon.ConclusionThe MDT approach is perceived as an effective method for breast cancer treatment planning and is a feature in most major centers in Korea. Further work is needed to ensure that the MDT approach operates as intended and that all breast cancer patients have access to an MDT.

PurposeThis study aims to evaluate the use of videoconferencing when conducting multi-disciplinary team (MDT) and handover meetings within an NHS Adult Learning Disabilities Intensive Support Team (IST). The IST have been conducting MDT and handover meetings “virtually” since the start of the COVID-19 pandemic in March 2020, in line with government guidance. It is pertinent to evaluate the effectiveness of using videoconferencing, as the move to flexible, remote working is detailed within the NHS Long Term Plan.Design/methodology/approachParticipants were members of the IST. A mixed methods approach using an online questionnaire collected participant’s views relating to the use of videoconferencing when conducting MDT and handover meetings, in comparison to previous face-to-face meetings. The questionnaire considered five key areas: accessibility, environment and communication, organisation, continuation of care and data protection and confidentiality. Results were collated and analysed.FindingsImprovements were reported relating to accessibility, as the virtual format allowed for easier attendance, provided greater flexibility in attending and inviting key stakeholders. A reduced sense of team connectedness was reported, related to the virtual environment. The majority of participants reported that they wish to continue to have the option to attend meetings virtually in future.Originality/valueThere are no previous papers evaluating the use of videoconferencing within ISTs during the COVID-19 pandemic. This study suggests that the use of videoconferencing to conduct MDT and handover meetings is effective within the IST and highlights points for consideration moving forward.

Background: Multidisciplinary team (MDT) meetings are vital for improving patient outcomes and treatment plans, yet their effectiveness remains uncertain. Existing research demonstrates that collaborative treatment plans in cancer care lead to better results than those made by individual practitioners. The impact of MDT meetings on patients' management outcomes is significant. Aim: To evaluate the distribution, characteristics, and diagnoses of cancer patients. Additionally, it seeks to assess the influence of MDT meetings on clinical decision-making and the subsequent impact on patient outcomes. Subjects and methods: A descriptive investigation analyzed a cohort of 150 cancer patients receiving care at Benghazi Medical Center from January to June 2022. Diagnoses were established through comprehensive clinical evaluations, laboratory assessments, radiographic imaging, and histopathological examinations. Medical interventions were determined collaboratively by a multidisciplinary team of healthcare professionals, leveraging their specialized expertise for optimal patient management. Results: The study found that individuals aged 41–60 comprised the largest proportion of cancer patients (49.3%). Females accounted for the majority (62%) of cases, and most participants were from Benghazi (69.3%). Gastrointestinal tract (GIT) cancers were the most prevalent (58.7%), followed by breast tumors in women (14.7%) and pancreatic tumors (6%). Treatment decisions, tailored to individual patient needs, were made collaboratively by the multidisciplinary team. Chemotherapy, radiotherapy, or a combination was chosen for 47.3% of cases, while surgical resection was appropriate for 30.7% of cases. The study's findings support the hypothesis that MDT meetings contribute to effective and up-to-date management guidelines. Neglecting discussions about cancer patients poses significant risks that can no longer be ignored. MDT meetings mitigate these risks and ensure comprehensive medical decisions. Conclusion: The study observed that chemotherapy and surgical resection were frequently selected as treatment options. It emphasized the importance of Multidisciplinary Team (MDT) meetings in guiding clinical decision-making. However, further feedback regarding the optimal format of MDT meetings is required. Establishing standardized MDT protocols is imperative for enhancing patient management outcomes.

People are becoming older and are suffering from more chronic diseases, partly because technical innovations have improved surgical safety. Since it is known that patients with multiple comorbidities suffer from more adverse events in the perioperative period, it is important to exactly identify those patients who might need extra attention from their multidisciplinary team (all the consultants and other health care workers involved in their perioperative care). According to a joint guideline from The Netherlands Societies of Anaesthesiology (NVA) and Surgery (NVVH) from 2010 these preoperative multidisciplinary team (MDT) meetings should be organized in every hospital in the Netherlands. This thesis is concerned with the identification of high-risk noncardiac surgical patients through the use of perioperative mortality risk calculators, with the state of execution of preoperative MDT meetings in the Netherlands, with the characteristics of the MDT meetings, with the outcome of the MDT meetings and patients. The thesis also started research to investigate more qualitative questions such as: what is the (cost) effectiveness of preoperative MDTs?, the quality of life after preoperative MDTs?, the state of disability after MDTs and the extent of disability free survival after an MDT and decision regret. This study received a grant from ZONMW (the Netherlands Organization for Health Research and Development) This thesis found that existing preoperative 30-day mortality risk calculators are not reliable enough for identification of high-risk patients at the preoperative screening clinics yet. A few models may be used after external validation of the calculator and maybe updating of the calculator as well. This thesis also found that only 50% of hospitals in The Netherlands have preoperative MDTs for noncardiac high-risk patients installed. Most patients were identified because of doubt regarding the harm-benefit ratio of the planned surgery and preoperative mortality risk calculators were calculated but never used for identification. Variation exists in execution of MDT discussions in The Netherlands. The anaesthesiologist is almost always present during the MDT discussions and the surgeon for more than 70%. During the MDTs for many patients an modification was suggested to the original treatment plan (73-81%) and discussed during multidisciplinary decision-making with the patient and their family after the MDT meeting. One third of the discussed patients did not have surgery after the MDT and 5-10% of the patients refrained from surgery after becoming aware of the higher stakes of their surgery. The treatment that was decided after shared-decision making was almost always executed according to plan. Adverse events were more frequent for the nonsurgical treatment group and more high-risk patients who had no surgical treatment died within 30 days. Variation was present between nine hospitals Guidelines are needed to implement and improve shared-decision making for high-risk noncardiac surgical patients in the Netherlands to be able to improve perioperative care for high-risk noncardiac surgical patients in all hospitals in The Netherlands.

Introduction: Multidisciplinary team (MDT) meetings are widely used across the UK to provide expert decisions and improve cancer outcomes. However, little is known about the underlying mechanisms of MDT decision-making. We investigated how decisions are made regarding the management of advanced ovarian cancer in gynaecological oncology MDT meetings. Methods: A cross-sectional observational study was performed, focussing on 41/ 223 MDT case discussions across six hospitals. The validated MDT-MODe tool was adapted to increase relevance to gynaecological oncology. Case information and contributions from seven disciplines were rated on a five-point Likert scale. Spearman’s correlation investigated relationships between factors and an exploratory factor analysis examined the underlying structure of MDT discussion. Results: Forty-one MDT decisions were made for patients with FIGO Stage III/IV ovarian cancer. MDT case discussions were structured by four factors: “Clinical Presentation,” “Patient Factors,” “Chair’s Direction” and “Input from Other Specialties.” Nurses were often quiet but facilitated discussion of patient factors. Junior doctors were not involved in MDT decision-making. Conclusions: The decision-making process in MDT meetings is driven by four underlying factors, the most significant of which represents patient history, tumour markers, images and radiologist input. Patient factors were underrepresented, and nurses should be empowered to overcome this.

The objective is to explore how clinical decisions are made in a cancer multidisciplinary team meeting (MDM). The study design is qualitative based on participant observation, in depth interviews, and questionnaires. The research setting was weekly cancer MDM which provides a forum for clinical debate for practitioners in the field of women's health, working within one Cancer Network in England. The participants were 53 practitioners attending a weekly MDM over a 4-month period. Analysis of nonparticipant observation data and practitioner interview narratives identified key influences on the work of the MDM, and in particular decision-making. The research identified three major influences on the conduct of the MDM. First, MDM discussions are dominated by those with surgical, medical, or diagnostic expertise with limited contributions from those with a nursing, palliative, or psychosocial background. Second, decision-making is shaped by an overriding need to comply with policy initiatives concerning the organization of diagnosis and treatment. The third influence is whether the patient is known or unknown to some degree by members of the MDM. Where there is preexisting knowledge of the patient, the discussion and decision is inclusive of a wider range of disciplines. Team working in these circumstances is an acknowledged source of satisfaction and motivation. Where the patient is not known, discussion concerns only the physical details necessary to make a diagnosis and contributions from the wider team (including those with knowledge of psychosocial care) are rare. Practitioners' sphere of expertise, Department of Health policy, and familiarity of the team with the patient are key factors in shaping decision-making in MDMs.

Mise en place des modalités de réunions de concertation pluridisciplinaire pour la prise en charge des patientes prédisposées héréditairement au cancer du sein. Une étude française