Abstract
BackgroundThe prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members’ views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting.MethodsMembers of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings.Results173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work.ConclusionKey urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical practice.
Highlights
The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally
Time spent at the urology MDT meeting The median time per week spent at the urology MDT meeting by Oncologists was 2.0 hours, by Urologists 2.0 hours (1–5 hours) and by Nurses 2.0 hours (0–5 hours) – with Oncologists spending significantly more time than Urologists or Nurses in other, non-urology MDTs (P ≤ 0.001; Kruskal Wallis test (KWT))
Emergent themes from the responses (N = 58) to the question about how the MDT meeting saves time later are Improving the efficiency of the MDT meeting Participants ‘agreed’ that at local or specialist MDT meetings, some cases, for which MDT review is currently mandatory, could be treated according to a pre-defined pathway
Summary
The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence is emerging of the benefits of multidisciplinary working in cancer care [1]. In the UK multidisciplinary team (MDT) working in cancer care has been mandatory for over a decade, and all cases of new or suspected cancer must be discussed in an MDT meeting [2]. Such teams, which involve surgeons, radiation and medical oncologists, radiologists, pathologists, sometimes specialist nurses (always in the UK) and MDT coordinators, work together and meet regularly (e.g. weekly) to plan investigations and treatment for patients [2]. Reviews indicate that overall MDTs do improve the care process, and the largest study that we are aware of to date on breast cancer patients indicates improved survival [1,3,4]
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