Impact Of Multidisciplinary Team Meetings Research Articles

PAEDIATRIC-15 MANAGEMENT OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS BY A NEURO-ONCOLOGY MULTIDISCIPLINARY TEAM : OUR EXPERIENCE

Abstract The outcome of pediatric central nervous system tumors has improved over the past decades due to advances in diagnostic testing, treatment and increased understanding of the disease biology. Nevertheless, the probability of survival of this tumors remains much lower in low-to middle-income countries. The gaps that prevent optimal clinical management of brain tumors are multifactorial and mostly related to underdiagnosis; a lack of specialized and dedicated radiologic, histopathologic, neurosurgical, radiotherapeutic, and oncology services, and a deficiency of coordinated multidisciplinary care in many centers. The aim of this report was to evaluate the impact of multidisciplinary team meetings on the clinical management of pediatric central nervous system tumors in Abidjan (Côte d'Ivoire). We retrospectively reviewed the clinical data of pediatric patients (aged <15 years) with central nervous system tumors diagnosed and treated in the Neurosurgery Department and National Center of Radiotherapy between 2019 (the year a neuro-oncological multidisciplinary staff was established) and 2023. Data on patient demographics, clinical notes, imaging studies, tumor characteristics and multidisciplinary team decision were collected from the multidisciplinary team database. During the multidisciplinary team meetings era, 40 pediatric central nervous system tumors were diagnosed and treated. The median age at diagnosis was 8.5 years. The mostly histological types were high grade and low grade gliomas. Decision-making was largely consistent with available guidelines. Therapeutic were surgery, external beam radiation treatment with concurrent and adjuvant chemotherapy. Benefits of neuro-oncology multidisciplinary team include coordination, direction for complicated cases, education, and a forum for communication, and clinical trials.

An Investigative Analysis of the Role of Multidisciplinary Teams in Cancer Management: Assessing Advantages and Obstacles

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.

Impact of Multidisciplinary Team Meetings on Decision Making in Vascular Surgery: A Prospective Observational Study

This cohort study aimed to prospectively determine the impact of multidisciplinary team meetings (MDTs) on treatment plans in vascular patients. The weekly MDT at the institution consisted of a structured discussion of vascular cases in the presence of at least one representative of each specialty from vascular surgery, angiology, and interventional radiology. Participants were asked to examine the cases entered on the digital MDT platform and to fill in forms with a detailed open text treatment recommendation for each patient. Individual recommendations were compared with the final MDT decision, which was based on a shared decision after discussion of clinical and radiological data. The primary endpoint was the agreement rate. The rate of decision implementation was determined to verify the adherence to MDT recommendations. Four hundred consecutive case discussions in 367 patients between November 2019 and March 2021 were included, excluding patients needing urgent treatment, yielding MDT discussion in 88.5% of carotid artery cases, 83% of aorto-iliac cases, and 51.7% of peripheral arterial cases, which included 56.9% of the chronic limb threatening ischaemia cases. The overall average agreement rate was 71% ± 41%. Analysis according to the specialty of the attending physician showed agreement rates of 82% ± 30% for senior vascular surgeons, 62% ± 44% for junior vascular surgeons, 71% ± 43% for interventional radiologists, 58% ± 50% for angiologists (p < .001), and 75% ± 38% considering only senior practitioners. The inter-rater agreement, resulted in kappa coefficients of 0.60 - 0.68 for senior vascular surgeons, 0.29 - 0.31 for junior vascular surgeons, 0.39 - 0.52 for interventional radiologists, and 0.25 for angiologists. The MDT treatment decision was implemented in 353 (96.2%) cases. The impact of MDT discussion on treatment recommendations and the adherence to MDT recommendations were significant and in line with results reported from other specialties.

Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility.

Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. Out of 50 cases, 66% (CI 53-79%; p<.005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.

The impact of adrenal tumor multidisciplinary team meetings on clinical outcomes.

Multidisciplinary team meetings (MDMs) to address various clinical problems have become common, especially for cancer care. However, the impact of MDMs on adrenal tumor care has rarely been reported. We organized an endocrine tumor MDM including adrenal tumors in August 2014. The objective of this study was to assess the impact of our adrenal tumor MDMs on patient clinical outcomes. We compared several parameters measuring clinical outcomes before and after MDMs were instituted. The adrenal tumor MDMs included an endocrinologists, urologists, radiologists, pathologists, and residents. We analyzed 128 consecutive cases of functioning adrenal tumors (primary aldosteronism (PA), n = 53; Cushing's syndrome (CS), n = 24; pheochromocytoma (PCC), n = 51) who underwent surgery in Kobe University Hospital from 2008 to 2019, and compared clinical parameters before (n = 68) and after (n = 60) MDMs were instituted. Twenty-one selected cases including PA, CS, PCC, adrenocortical carcinoma, and metastatic adrenal tumor were discussed in the MDM. In the analysis of 128 cases, the difference between pre- and postoperative systolic BP (ΔBP) in patients with PA after MDMs were instituted was smaller compared with those before (p = 0.02). In CS, preoperative steroid synthesis inhibitors were used more often (33 vs. 100%, p < 0.01), postoperative plasma ACTH levels were higher (29.1 vs. 84.5 pg/mL, p < 0.01), and postoperative decrease in systolic BP was milder (p < 0.01) after MDMs were instituted. In PCC, doses of preoperative doxazosin were higher (p < 0.01) after MDMs institution. Operating time, bleeding volume, and cure rate did not differ between each tumor type. These data suggest that instituting MDMs improved the perioperative management of functioning adrenal tumors.

Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases.

Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.

The impact of multidisciplinary team meetings(MDTMs) in cancer care:evidence from an umbrella review

The impact of multidisciplinary team meetings(MDTMs) in cancer care:evidence from an umbrella review

Evaluation of Multidisciplinary Team Meetings in Uro-Oncology

The objective of this study was to examine the impact of multidisciplinary team meetings on the management decisions for urological cancers. A pro- spective study was conducted. The study popu- lation is cases presented to multidisciplinary teams at Notre- Dame de Secours University Medical Center between July 2012 and July 2014. Data was collected by a standard pro forma. 189 cases were presented in multidisci- plinary meetings during the study period. Results of this study showed that multidisciplinary team meetings change management decisions in 40.7% of cases. Change in man- agement decisions was mainly significant in testicular can- cer (57.1%), prostate cancer (42.7%) and bladder cancer (38.2%), with less important changes in renal cancer (33.3%). Prostate cancer cases with Gleason score 7 (51.7%) and bladder tumors with TNM ;t T2 (85.7%) were the most mod- ified in their respective groups. Multidiscipli- nary team meetings have a major impact in therapeutic de- cisions taken by urologists for newly diagnosed urological cancers.

The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature.

Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting* OR multidisciplinary discussion* OR multidisciplinary conference* OR case review meeting* OR multidisciplinary care forum* OR multidisciplinary tumour board* OR case conference* OR case discussion* AND oncology OR cancer. Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines.

Waiting times for cancer treatment: the impact of multi-disciplinary team meetings

In the UK, treatment recommendations for patients with cancer are all made within multi-disciplinary team (MDT) meetings. This has benefits, but it may delay treatment starting if MDT decisions require revision before implementation. This study examined whether changes in MDT treatment decisions after the meeting led to a delay in the start of treatment. Consecutive MDT treatment recommendations were recorded and times to start of treatment were calculated. Comparisons of the time from MDT meeting to start of treatment were made between implemented and non-implemented MDT recommendations. Of 363 MDT recommendations, 71 (19.5%, 95% CIs 15.6–24.0) were not implemented. The median time to start of treatment was 24 days (IQR 12–33), increasing to 35 days (IQR 17–77.5), if the MDT decision required revision to another active therapy (p = 0.009). Decisions were changed because details about co-morbidity (n = 32, 45%), new clinical information (n = 24, 34%) or patient choice became apparent (n = 13, 18%) and two changed for no clear reason. Significant delays in starting treatment occur if team treatment recommendations are not implemented. Effort and resources are required to ensure that information is present at meetings to allow comprehensive patient-centred decisions to be made and implemented.

EXPERIENCES OF PROFESSIONALS PROVIDING COMMUNITY CARE FOR DISABLED PEOPLE IN NAGASAKI AND SOUTHAMPTON

To report on the factors affecting the resolution of problems experienced by community care professionals and to refine a checklist of methodological issues for future cross-cultural comparative studies. A preliminary comparative study between Japan and the UK. 630 subjects in Nagasaki, Japan and 109 subjects in Southampton, UK who were physically disabled, aged over 40 years, living at home and currently using at least 1 of the community disability care services. Community care professionals from a range of professions were asked about the backgrounds, physical disabilities and needs of their disabled subjects, and the difficulties experienced in providing them with care and rehabilitation services. The proportion of subjects for whom difficulties were experienced in providing services increased with increasing severity of disability in Southampton. By contrast, this trend was less pronounced in Nagasaki where difficulties were reported in approximately 95% of all cases. However, it proved much more difficult to enlist collaboration for this survey in Southampton than in Nagasaki and this led to selection bias in the Southampton sample. The professionals in Nagasaki were hampered by a lack of medical information about their subjects and by a lack of available resources for relieving family members from some of their burden of care. The nature and impact of multidisciplinary team meetings appeared to differ in the 2 countries. It is suggested that the provision of medical information and advice to staff working in community care is a factor of fundamental importance in enabling them to define objectives and to help identify disabled people's care and rehabilitation needs. The means by which such information and advice is shared appeared to differ in the 2 countries. Attenuated resources for community care and poor linkage between care organizations impair the ability of professional staff to resolve problems once they have been identified. It is suggested that each country could learn something from the other in improving the efficiency and impact of multidisciplinary community-based teams. In order to avoid the methodological difficulties in study design and implementation that we experienced, a 7-point checklist has been constructed to assist others who may be planning further cross-cultural studies in this field.