Multidisciplinary Team Process Research Articles

WP8.1 - Perceptions of Higher General Surgical Trainees and Trainers towards Multidisciplinary Team assessment: A deanery’s experience of the new General Surgical curriculum

Abstract Aims Explore how multidisciplinary team (MDT) working is assessed as a capability in practice (CiP). Understand perceptions of problems with assessment of MDT as a CiP. Methods Semi-structured interviews were conducted virtually with 8 Higher Surgical Trainees (HST) and 4 Trainers following recruitment within a single deanery. Interviews were transcribed and analysed using reflexive thematic analysis. Ethical approval was granted. Results Most participants did not feel that they engaged meaningful with assessment of MDT as a CiP. Despite forming part of the Multi-Consultant Report (MCR), 75% of trainers were unaware of any formal assessment and expressed confusion over the introduction of the new curriculum. All participants reported that they felt MDT as a CiP was most appropriate for senior HST, particularly those peri-FRCS. HST felt excluded from the MDT process while trainers felt trainees did not engage. Trainees placed more value on MDT assessment in their declared subspeciality. All interviewed expressed that other activities were prioritised above MDT, particularly operating. When assessed, participants felt it was based on a balance of knowledge, presentation and preparation. Both HST and trainers felt participation rather than attendance was vital but currently not practiced. When considering grading of assessment, there was confusion from all participants in how to differentiate Level3 (Indirect Supervision) from Level4 (Day1 consultant), particularly in the context of multiple trainers in attendance. Conclusion Implementation of MDT as CiP has caused confusion among HST and trainers. It is poorly used and valued. The CiP is perceived as more beneficial to senior HST.

FP1.3 - SPEC MDT in Aneurin Bevan University Health Board

Abstract Aims The SPEC (significant polyp and early cancer) multi-disciplinary team (MDT) meeting was started in ABUHB in 2022 to discuss complex colonic and rectal polyp cases, such as polyps >20mm, likely to be sessile, or difficult to remove endoscopically. The aim was to evaluate the effectiveness and clinical role of the SPEC MDT. Methods Data for patients discussed in SPEC MDT since its conception in January 2022 until September 2023 was retrospectively collected from the SPEC MDT database, a prospectively collected database. This included patient demographics, reason for referral, polyp characteristics and MDT outcomes. Results In 21 months, there have been 38 SPEC MDTs, with 355 cases discussed (average of 9 cases per MDT). There was at least one laparoscopic colorectal surgeon, gastroenterologist and a histopathologist in every MDT in accordance with BSG guidelines. Main referral reasons included endoscopy findings (72%) and re-discussion post-procedure (22%). Twenty-three patients had adenocarcinomas and three had NETs. MDT outcomes were EMR (23%), endoscopic surveillance (21%), clinic to discuss (no) surgery (19%), TAMIS (16%), urgent endoscopy (13%) or other (8%). Conclusion As the busiest Health Board in Wales for Colorectal Cancers, the formation of SPEC MDT has been an important step in improving the detection and treatment of advanced polyps and early cancers. Although too early to measure the impact on early cancer detection rates and improved decision making for these patients, formalising the MDT process in line with BSG guidelines has been an important step in improving the service offered to patients.

Enhancing Multidisciplinary Team Processes in Lung Cancer Care: A Self-Assessment Toolkit and Best Practices

Multidisciplinary teams (MDTs) play a pivotal role in the comprehen­sive management of cancer. MDT meetings (MDTMs) bring together specialized experts across the entire patient care spectrum, convening regularly to discuss patient cases, select optimal diagnostic strategies, and determine the most ap­propriate treatment modalities. By fostering cross-disciplinary interaction, MDTs aim to enhance patient outcomes and elevate the collective proficiency within a health care institution, promoting knowledge dissemination and ensuring health care practitioners remain abreast of the latest clinical insights. This study’s methods comprised an extensive review of existing literature coupled with in­terviews involving lung cancer MDTs from 24 medical centers across Europe and Canada. The research focused on elucidating dynamics and variations observed among lung cancer MDTs, outlining an optimal MDT process, identifying varianc­es in the study sample, and introducing a comprehensive self-assessment tool­kit for continuous evaluation and improvement. The report discusses how these results should be used to self-optimize hospital MDTs, promote standardization, and encourage increased cross-hospital best practices sharing. With this, MDTs will be better positioned to deliver on the key goal of improved patient outcomes while promoting equality of access to health care.

Combined positron emission tomography and contrast enhanced CT (PET/CeCT) is a feasible single investigation in the staging of oesophagogastric cancers: single-centre pilot study experience during the COVID-19 pandemic.

Staging of oesophagogastric (OG) cancers usually involves endoscopy (OGD), and separate visits for contrast enhanced computed tomography (CeCT) and positron emission tomography (PET/CT). At the height of the COVID-19 pandemic, some of our patients underwent single-visit combined staging with PET/CeCT. We compare this novel pathway with standard separate imaging in time to completion of staging, to start of treatment, and cost. We identified all patients discussed at our OG multidisciplinary team (MDT) meeting in 2020. Clinical records revealed dates of investigations and treatments. Data were tabulated in Excel, with statistical analysis in SPSS. All patients followed the same MDT process and image reviewing criteria. Costs were compared using prices supplied by finance departments. A total of 211 new patients were discussed at our MDT in 2020. Of these, 48 patients had combined PET/CeCT staging, and 68 had separate scans. Median time (interquartile range) in days from OGD to final imaging was 9 (6-23) for the combined group versus 21 (16-28) for the separate group (p≤0.001). Median time (days) from OGD to treatment start was 37 (29-52) for combined versus 55 (40-71) for separate (p≤0.001). No combined scans were of insufficient diagnostic quality for the MDT. PET/CeCT had a potential cost saving of £113 per patient. PET/CeCT allows accurate radiological staging of OG cancers with a single scan. Patients completed staging and started treatment faster, with a potential saving of £10,509 in one year. PET/CeCT has become standard staging at our trust, and we aim to incorporate radiotherapy planning images too.

How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)

BackgroundStroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings.MethodsThis qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context–mechanism–outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively.ResultsWe interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography.ConclusionsDespite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings.Trial registrationISRCTN: 15,568,163, registration date: 26 October 2018.

‘Still travelling’: Access to abortion post-12 weeks gestation in Ireland

This article focuses on access to abortion in Ireland post-12 weeks gestational age. It critically examines abortion access under the legislative sections 9, 10 and 11 of the Health (Regulation of Termination of Pregnancy) Act 2018, the Multi-Disciplinary Team (MDT) process, as well as the appeals process in place. We highlight existing ambiguities in diagnosing and certifying cases of risk to health during pregnancy, particularly mental health, as well as the challenges in diagnosing and certifying cases of fatal fetal abnormality (FFA). The article incorporates service users' experiences in obtaining abortion in Ireland post-12 weeks, particularly in cases of FFA, and includes recommendations for policy and legislative change.

Streamlining the Multi-Disciplinary Team Meeting: The Introduction of Robust Pre-Preparation Methods and Its Effect on the Length of Case Discussions.

The multidisciplinary team (MDT) approach has long been considered the optimal way in which to deliver a high standard of care to patients with breast cancer. With a growing number of patients and ever-increasing complexity of cases, the strain on time and resource of the MDT is becoming increasingly evident. It is therefore essential that local hospital departments adapt their MDT processes to better streamline discussions and optimise efficiency. The Royal United Hospital in Bath is a district general hospital in the UK. Approximately 500 patients with cancers are treated annually, and the MDT discusses approximately 60 patients per week. To improve our MDT meeting processes and increase productivity, we created a concise MDT template using Microsoft Access™: giving all clinicians the ability to add patients and information in real time. We also allocated weekly preparation time whereby a senior clinician ensured all patients were prepared prior to the meeting with results and potential outcomes prepopulated where possible. We recorded the time spent discussing patients during 6 MDT meetings before and after implementation of changes. Cases were classified by pathology category to determine if there were differences following the preparation changes. Overall, we significantly reduced our average MDT discussion time (p=0.02). We significantly reduced average discussion time in postoperative malignant cases (p<0.0006) and expected benign core biopsy cases (p<0.0047), allowing appropriate redistribution of time towards discussion of more complex cases, reflected by the significant increase in time spent discussing complex radiology cases (p<0.025). We offer an effective method for improving the MDT meeting preparation and presentation by ensuring each patient is appropriately prepared prior to the meeting, and outcomes for those simple cases are already prepopulated. This creates additional time within the meeting to discuss more complex clinical cases while allowing all members of the team an opportunity to discuss all patients if needed.

P-017 A FRAMEWORK FOR MULTIDISCIPLINARY TEAM MANAGEMENT OF ABDOMINAL WALL RECONSTRUCTION

Abstract Aim Incisional hernias are common and can significantly impact a patient's quality of life. Traditionally, abdominal wall reconstruction (AWR) has been performed by general surgeons, or those with special interest, often working in isolation. However, there is increasing awareness of pre-optimisation, risk stratification, enhanced training, and personalising treatment using a wide range of techniques. Methods &amp; Results For complex and higher-risk procedures, Multidisciplinary team (MDT) management is considered the standard of care for optimising outcomes. The lack of standardised protocols and clear evidence in AWR means that surgical management can vary greatly. This makes the MDT process even more important due to the complexity of the decision-making involved. We describe a successful MDT process for complex abdominal wall reconstruction at a tertiary referral centre. Patients are reviewed at weekly AWR meetings with a multidisciplinary team, which includes consultants, advanced clinical practitioners and trainees. This is an opportunity for objective risk stratification, radiological review and assessment of the patient's goals before preoptimization and operative planning. Prospective data is collected on all patients to allow for quality improvement and service development. Conclusion MDT management of abdominal wall hernia is gaining popularity but remains poorly established in most regions. The involvement of surgical colleagues and other specialists is crucial in developing this growing field of surgery. We hope to expand our team to include Radiologists and Nutritionists, with the possibility of extending to regional networks, as we continue to explore new techniques and methods in managing complex abdominal wall hernias.

Healthcare professional experiences of making surgical oncology decisions and delivering COVID-19 safe care: a qualitative study

Background The COVID-19 pandemic was declared a public health emergency in March 2020. The British National Health Service (NHS) redirected medical attention towards prioritising COVID-19-positive patients in favour of less urgent care affecting cancer service provision. This study aims to explore experiences of healthcare professionals (HCPs) and investigate the impact of COVID-19 on decision-making in surgical oncology. Methods HCPs with experience in surgical oncology were recruited from January 2021 to June 2021. Qualitative semi-structured telephone interviews were conducted and transcribed verbatim. Interviews were conducted until data saturation. Thematic analysis was used to identify frequently discussed themes. Results A total of 13 participants were interviewed, identifying three main pandemic-related challenges: multi-disciplinary team (MDT) processes – telephone pre-operative assessments impoverished information elicited from in-person examination; service delivery – personal protective equipment (PPE) added complexity to surgical practice and more difficult communication; work routines – increased workload to deliver COVID-safe remote practices and decreased training time. Conclusions COVID-19 influenced cancer service provision with teams making significant changes to ensure that effective clinical reasoning and surgical standards were maintained. Managing safe COVID-19 surgical care impacted daily-life and work stressors. Post crisis, service delivery is looking to integrate telemedicine within care whilst reducing its impact on workload and in-practice training.

A Multi-Disciplinary Approach for the Management of Prosthetic Joint Infections: An Australian Perspective.

Introduction:Prosthetic joint infections (PJI) are a major complication of hip and knee arthroplasty, imposing significant morbidity and mortality. Orthopaedic oncology units have utilised a multi-disciplinary team (MDT) approach for some time. PJI is not only an equally life-threatening condition, it also requires input from multiple healthcare personnel and treatment can vary significantly between individuals given the diversity in microbiological, surgical and host factors. Our arthroplasty service established an MDT meeting to manage this complex patient group. This study describes the philosophy and implementation of an MDT approach to the management of PJIs at a tertiary hospital in Australia.Materials and methods:A retrospective review of all patients that presented to the MDT PJI meeting from October 2017 to April 2020 was performed. Patient characteristics, microbiological profile and management were reviewed.Results:One hundred and one patients were reviewed over 2.5 years with a mean age of 69.2 years (SD 11.9). Patients presenting predominantly had a primary TKR (32%) or primary THR (22%). Results of Microbiology cultures varied, with 42% Gram-positive organisms, 13% Gram-negative organisms, 2% fungus and 1% yeast origin. Management mainly consisted of two-stage revision (28%), debridement-antibiotics-and-implant retention (22%) and antibiotic suppression (14%). A total of 91.5% of patients who underwent surgical management were considered cured at one year.Conclusion:PJIs are complex and require coordinated care by a number of healthcare personnel. The MDT process has allowed collaboration between Orthopaedic, Infectious Disease and Microbiology departments and aims to improve the quality of care provided to patients, potentially reducing morbidity and mortality of patients with PJI.

Perspectives of Pharmacists on the Structure, Decision-Making, and Communication Practices of Multidisciplinary Cancer Teams in Alabama.

Introduction: A multidisciplinary team (MDT) approach within cancer care settings is increasingly being adopted to improve patient outcomes due to the rising complexity of diagnosis and treatment. This study aims to explore the perspective of pharmacists on the structure, decision-making process, and communication practices of cancer MDTs. Methods: A 25-item online questionnaire was distributed to oncology-related clinical pharmacists in Alabama. Data were analyzed using descriptive statistics. Results: A total of 15 pharmacists completed the survey. More than half of the respondents reported that MDT meetings were held mostly in person on a set schedule. While physicians primarily facilitated the meetings, patients and/or their caregivers were largely not invited to participate in them. The treating physician oversaw delivering and update to the patient and/or their caregivers after the MDT meetings. Most respondents indicated that positron emission and computed tomography were the most common sources of information available at initial case presentations. Overall, respondents strongly agreed that they felt comfortable sharing their opinions with others health professionals during MDT meetings. Conclusions: This study provides evidence that oncology pharmacists are involved in MDT decision-making processes and communications but suggests the need to promote conditions to further their participation.

Multidisciplinary Team Decisions in Management of Abdominal Aortic Aneurysm: A Service and Quality Evaluation

ObjectiveTo investigate whether decisions made by the multidisciplinary team (MDT) were implemented and review the MDT process to identify areas for improvement.MethodsThis was a retrospective service evaluation project. Consecutive cases of abdominal aortic aneurysm (AAA) from vascular surgery MDT meetings were reviewed. MDT outputs were extracted and compared with implemented clinical management obtained from the electronic health record (EHR) to determine concordance. Cases were re-reviewed to understand reasons why planned management was not implemented.ResultsFrom 42 MDT meetings, 106 patients were identified. Twenty four patients were discussed at two MDTs and four patients were discussed three times. Of the 106 patients, 91 (85.8%) were treated as planned, seven (6.6%) declined planned management and opted for conservative management, four (3.8%) patients died before treatment, and four (3.8%) had alternative management for individual reasons. Of the patients discussed multiple times, 15 (53.6%) needed review by a consultant anaesthetist or additional investigations.ConclusionThis service evaluation found a similar proportion of cases as in existing oncology literature where the MDT decision was not implemented. However, the natural history of AAA brings nuance to this finding. Facilitating patient preference is an important problem that will require future study. This evaluation resulted in local improvements to the MDT process for AAA.

Multidisciplinary teams caring for people with variations of sex characteristics: a scoping review

BackgroundIn 2006 the Chicago consensus statement on the management of people with variations of sex characteristics (VSC) acknowledged the importance of a multidisciplinary team (MDT) approach. The consensus update from...

EP.FRI.745 Information Sustainability: SCR+: A bespoke module to optimise information flows around the Somerset Cancer Register to enhance the multidisciplinary cancer team process

Abstract Background Many surgeons work within multidisciplinary cancer teams. The Somerset Cancer Register (SCR) is a national reporting system for service performance which is in use in more than 100 NHS Trusts. However, the core system has not yet been optimised for MDT users or for the surfacing of clinical data for research and other uses. Methods SCR replaced our legacy cancer reporting system in 2014. Working with the SCR developers, we integrated our cellular pathology and imaging records with the SCR MDT outputs. We subsequently developed SCR+ to optimise workflows for MDT coordinators and information presentation to clinical users. Results Our HTML-enabled SCR+ software application displays all cancer patients by pathological type and year of presentation on dynamic histograms, for ease of visualisation and interaction. Every selected case is displayed in list order for each and every MDT meeting, with a fast hyperlink to our integral Lifelines EPR interface, to electronic pathology records back to 1990, and to our Breast Cancer Data System for relevant patients. Conclusions The SCR+ module transforms the access and visualisation of cancer workload across our Trust for all authorised MDT users, with appropriate data security. The agile programming methodology allowed us to build a sustainable cancer data system with further development potential. The product substantially enhances user experience, data recall and productivity over legacy systems. Close cooperation between clinically proficient IT teams and clinicians as the end consumers of digital health data systems yields significant operational benefits at pace and with very modest costs.

Surgical management of suspected gallbladder cancer: The role of intraoperative frozen section for diagnostic confirmation.

Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's intraoperative assessment alone, and with the addition of intraoperative frozen sections, for suspected gallbladder cancers from a tertiary hepatobiliary multidisciplinary team (MDT). MDT patients with complex gallbladder disease were included. Collated data included demographics, MDT discussion, operative details, and patient outcomes. A total of 454 patients with complex gallbladder disease were reviewed, 48 (10.6%) were offered radical surgery for suspected cancer. Twenty-five underwent frozen section that led to radical surgery in 6 (25%). All frozen sections were congruent with final histopathology but doubled the operating time (p < 0.0001). Both the surgeon's subjective and additional frozen section's objective assessment, allowed for de-escalation of unnecessary radical surgery, comparing favourably to a 13.0% cancer diagnosis among radical surgery historically. The MDT process was highly sensitive in identifying gallbladder cancers but lacked specificity. The surgeon's intraoperative assessment is paramount in suspected cancers, and deescalated unnecessary radical surgery. Intraoperative frozen section was a safe and viable adjunct at a cost of resources and operative time.

Acute kidney injury and continuous renal replacement therapy: A nursing perspective for my shift today in the intensive care unit.

Handover, clinical discussion, and care for patients in the Intensive Care Unit (ICU) require visual cues to a verbal "story" in an attempt to quickly understand the patient status. Continuous renal replacement therapy (CRRT) is often associated with sepsis or a toxic cause and "kidney attack" not apparent to the patient; "silent" with no pain, discomfort, or vital sign changes initially. Language, terminology, and definitions for this acute kidney injury (AKI) are a graded classification with guidelines. CRRT and dialysis techniques use the physiological principles of diffusion and or convection for solute removal providing a replacement for the basic kidney functions to sustain life until function returns. When to stop CRRT is based on clinical assessment of the patient overall status and urine production re-starting. The medical treatment is focused on the key interventions of resuscitation, remove the cause, support with CRRT or dialysis and monitor for recovery of function. CRRT requires a multidisciplinary team and quality process, local policies, education, and competency pathways to promote best outcomes and efficacy.

Multidisciplinary team processes parallel natural disaster preparedness and response: A qualitative case study

Cross-disciplinary (multidisciplinary, interdisciplinary, or transdisciplinary) teams are increasingly recognized as crucial alliances required for solving complex problems, particularly those attributable to natural disasters. Despite this recognition, there has been limited research examining the factors necessary for successful cross-disciplinary collaboration at the outset of a research initiative to address natural disaster preparedness and response. The purpose of this study was to explore the facilitators of and barriers to such collaboration through a case study of a multidisciplinary research initiative at an urban East Coast university in the United States. Using an applied qualitative approach, we conducted individual semi-structured interviews with initiative members to explore facilitators and barriers to natural disaster preparedness and response, and initiative members' attitudes, perceptions, and expectations regarding multidisciplinary collaboration. We identified several common themes across natural disaster preparedness and response efforts and multidisciplinary research collaborations, such as greater human and financial resources. Additionally, we identified several themes unique to perceptions of multidisciplinary research collaboration, such as the importance of clearly defined structures, and the needs of all parties being met. Findings may serve as a framework for multidisciplinary academic collaborations preparing for and responding to natural disasters, as well as multidisciplinary collaboration in general.

Therapeutic effect and clinical cost of multi-disciplinary team model of hepatoblastoma in children

Objective To summarize and analyze the treatment process, long-term efficacy and clinical economics of children's hepatoblastoma (HB) in multi-disciplinary team (MDT) mode, so as to provide basis for the rational choice of diagnosis and treatment. Methods From January 2014 to February 2019, 13 cases of hepatoblastoma in children who completed the whole treatment course in the Pediatric Hematology Tumor Ward of Peking University First Hospital were collected and analyzed, and were followed up until June 30, 2020. There were 9 males and 4 females who were diagnosed and treated according to the MDT process in the hospital. The median age was 16 months (2-54 months), 69.23% (9/13) were under 2 years old. The characteristics, diagnosis and treatment process and treatment effect of the cases were summarized, and the cost of clinical treatment was analyzed. Results According to the pretreatment extent of disease(PRETEXT), there were 1, 9 and 3 children with stages Ⅱ, Ⅲ and Ⅳ. 76.92% (10/13) of the patients had the largest tumor diameter > 10 cm. All the patients received preoperative neoadjuvant chemotherapy (8 patients received 4 cycles of chemotherapy, and 6 patients changed the chemotherapy plan), surgical treatment and postoperative chemotherapy, the tumor volume decreased by more than 50% (64%-95%) in 12 cases, except 1 case with no significant increase of alpha fetal protein and multiple lesions.The median length of stay was 87 days (68-214 days), the median cost of stay was 200 000 yuan (115 000-500 000 yuan), the median length of stay was 7 days (5-17 days), the median cost of stay was 20 000 yuan (15 000-60 000 yuan), and the incidence of postoperative complications was 7.69% (1/13). All the patients were followed up for 16-69 months. All the patients survived. Conclusion Under the MDT mode, the treatment is seamless connection, the long-term prognosis of children with HB is good, and the total hospitalization cost and time are within the acceptable range. Standard preoperative neoadjuvant chemotherapy can significantly reduce the tumor, improve the resection rate, reduce postoperative complications, reduce the total individual expenditure, shorten the total hospital stay, and further improve the long-term disease-free survival rate.

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

1187P Characterization of the gastroenteropancreatic neuroendocrine tumour patient journey

With increasing incidence and prevalence of gastroenteropancreatic neuroendocrine tumours (GEP-NETs), there is a need to identify inefficiencies in patient management. To provide a view of the journey for patients with GEP-NETs, healthcare professionals (HCPs) and patients from the USA and EU4 (France, Italy, Spain, UK) were interviewed with responses analyzed to determine consensus views. Fifty-four interviews were completed (49 HCPs, five patients). Time to first diagnosis of GEP-NET takes 5–7 years on average and misdiagnosis is common. Multidisciplinary team (MDT) structure and dynamics vary by practice type, institution, and country. In academic settings, GEP-NET is discussed in gastroenterology and/or hepatobiliary tumour boards, but centres with large case volume may hold NET-specific MDTs. Nuclear medicine physicians are increasingly involved in MDTs across many institutions, where they are consulted on patient eligibility for peptide receptor radionuclide therapy (PRRT). In the USA, medical oncologists are the primary treatment decision-makers, while gastroenterologists and endocrinologists are more involved in decisions in Europe, depending on tumour localization. Surgery-ineligible first-line cases are widely managed with somatostatin analogue therapy, and systemic options including PRRT and liver-directed therapies are provided for patients with metastatic disease. While PRRT is commonly used in second-line for low grade, well-differentiated tumors, it can be considered in first-line for patients with poorly differentiated fast-growing, somatostatin receptor-positive tumours. Treatment sequencing depends highly on physician attitudes and logistical barriers. HCP follow-up varies according to treatment and experience with GEP-NET. The rarity of GEP-NET, along with its late diagnosis and misdiagnosis can lead to complexities and uncertainty in sequencing when selecting the right therapy. Differences in management decision vary amongst institutions and countries, and the involvement of nuclear medicine physicians in the decision-making process of MDTs can improve awareness to availability of a treatment option such as PRRT.