Abstract
Two decades since their inception, multidisciplinary teams (MDTs) are widely regarded as the 'gold standard' of cancer care delivery. Benefits of MDT working include improved patient outcomes, adherence to guidelines, and even economic benefits. Benefits to MDT members have also been demonstrated. An increasing body of evidence supports the use of MDTs and provides guidance on best practise. The system of MDTs in cancer care has come under increasing pressure of late, due to the increasing incidence of cancer, the popularity of MDT working, and financial pressures. This pressure has resulted in recommendations by national bodies to implement streamlining to reduce workload and improve efficiency. In the present review we examine the historical evidence for MDT working, and the scientific developments that dictate best practise. We also explore how streamlining can be safely and effectively undertaken. Finally, we discuss the future of MDT working including the integration of artificial intelligence and decision support systems and propose a new model for improving patient centredness.
Highlights
Two decades since their inception, multidisciplinary teams (MDTs) are widely regarded as the ‘gold standard’ of cancer care delivery
Others may have additional functionality, such as those that can be integrated into electronic medical record (EMR) systems and harness artificial intelligence (AI); with the most advanced being cognitive computing systems that store and index current literature, protocols, and patient charts, learning from cases and improving the performance of the MDT [43,44,45]
clinical decision-support system (CDSS) have huge potential to improve the consistency of MDT management recommendations and their convergence with guidelines by assisting with the collation of all relevant information for case discussion, highlighting the current evidence base, and providing data on previous management decisions for similar cases
Summary
‘The MDT Observational Assessment Rating Scale’ assesses 18 elements of good team functioning as expressed in national UK guidance ‘The Team Evaluation and Assessment Measure’ assesses core functions of the team and their team meetings, based on the components defined in ‘the characteristics of effective MDT’. Others may have additional functionality, such as those that can be integrated into electronic medical record (EMR) systems and harness artificial intelligence (AI); with the most advanced being cognitive computing systems that store and index current literature, protocols, and patient charts, learning from cases and improving the performance of the MDT [43,44,45] Such systems have demonstrated improvements on process outcomes, such as preparation time and guideline adherence across a number of settings in oncology, including MDTMs. To date, no improvements in clinical outcomes have bene demonstrated [46]. CDSSs have huge potential to improve the consistency of MDT management recommendations and their convergence with guidelines by assisting with the collation of all relevant information for case discussion, highlighting the current evidence base, and providing data on previous management decisions for similar cases They offer potential for personalisation of treatment plans with the integration of molecular medicine, genetics and clinical trials, including those beyond the immediate network. It may be desirable to supplement this with periodic face-to-face interaction that permit more nuanced communication regarding performance, operational policy, challenges, and future directions [65]
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