Functioning Of Multidisciplinary Team Research Articles

Abstract PO5-11-01: Audit of multidisciplinary team meetings for improving breast cancer care

Abstract Introduction: Multidisciplinary team (MDT) meeting is a well-established method of optimising care for breast cancer patients. However, its effectiveness has not been proven yet. The present study aims to audit the functioning of MDT at a tertiary care hospital in a low-middle income country. Methods: This study examines the prospectively maintained database of patients being discussed in MDT meetings occurring from August 2018 till June 2023. The MDT was suspended for few months in between owing to the COVID pandemic. The analysis was done in terms of indications of discussion, referring department, modification in the pre-MDT plan, new investigation advised, radiological and pathological concordance, significant change in management strategy and interesting cases. The analysis is both qualitative and quantitative. Quantitative analysis involves percentages, mean and median. Results: MDT at our institute was conducted every Saturday at 12 noon as an in-person meeting. The MDT was suspended from May 2020 till June 2021 in view of the pandemic. It was restarted in July 2021, on an online platform and is continued as such. A total of 473 cases were discussed with 181 (38.2%) benign causes and rest were malignant. The most common indication of discussion for malignant cases was feasibility of breast conservation (59.9%) followed by ruling out recurrence/residual disease (17.4%). The indication for benign cases was rad-path concordance and ruling out phyllodes in a case of fibroepithelial lesion. In 31.4% of the cases the plan was modified from the pre-MDT plan and there was improved care. 34.7% cases were advised to get a new investigation done in form of contrast enhanced mammogram or MRI. Seventy nine percent cases were feasible for BCS, and it was done involving few complex surgeries as well. The most common indication for deferring BCS was extensive DCIS. The total number of man hours spent in preparation as well as MDT were analysed with improved clinical care and revealed the MDT to be a time intensive exercise with poor efficacy in terms of hours spent per patient. The time to decision making was increased at an average of 7.5 days for these patients. Conclusion: MDT helps to achieve goals of superior clinical care for both benign and malignant breast disorders at the cost of increased time to decision. It is labour intensive with capability of changing decision in one third of the cases. However, MDT needs regular audit to ensure optimum care with available resources. Citation Format: Kanika Sharma, Gopal Puri. Audit of multidisciplinary team meetings for improving breast cancer care [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-01.

Barriers to Multidisciplinary Team Approach in End-of-life Decision-making: Insights from an Indian Hospital

A common perception about multidisciplinary team (MDT) approach is that it improves the quality of care to hospitalised patients. However, there is paucity of information on the challenges in implementing such an approach in end-of-life care (eolc). Conducted in a multispecialty hospital in Kolkata (India), the present study explores barriers to MDT functioning in the context of ‘eolc’. The study finds the MDT approach fails to live up to its rhetoric. One of the major challenges is a professional boundary that inevitably arises in MDTs. Due to this, specialist physicians fail to overcome disciplinary boundaries to make consensus end-of-life decisions. Moreover, in the physician-dominant medical team, where nurses and other non-clinical caregivers’ roles are marginalised, holistic caregiving is compromised. The hospital environment is also not conducive to multidisciplinary teamwork. Application of a disease-specific treatment protocol in ‘eolc’ cases jeopardises team coordination, adversely affects ‘eolc’ referrals and disrupts care transfers. Dying patients and their families are especially affected by such discordant care. Based on the findings, the study suggests that while team approach is imperative to effective ‘eolc’, there is a need to shift focus from multidisciplinary to transdisciplinary approach to enhance care integration and patient-centric care to terminally ill patients.

Multiprofessional Team Performance In The Intensive Care Unit: Challenges And Perspectives

Background: The assistance provided in Intensive Care Units is focused on specialized care for patients in critical condition. Considering critical patients admitted to Intensive Care Units, multidisciplinary care consists of complex and special care. In this context, the question arises about the role of multidisciplinary team assistance in implementing adequate care centered on the patient as a whole and not just focusing on the disease. Objective: The study aimed to investigate in national publications the challenges and perspectives of the multidisciplinary team's performance in the Intensive Care Unit. Methodology: This is a bibliographic review article in which an exploratory research was carried out, with a qualitative approach. The search took place in the LILLACS and SCIELO databases from February to May 2023. 22 scientific articles were analyzed using as inclusion criteria articles published in Portuguese; complete, published and indexed in the aforementioned databases in the last ten years. Results: As a result, it became clear that the know-how of different categories of health professionals working together plays a fundamental role in the care of critical patients in the Intensive Care Unit and this requires these professionals to have scientific knowledge and technical skills in care services. Furthermore, they must seek to provide qualified, comprehensive, multidisciplinary care based on scientific evidence. It was concluded that assistance to critically ill patients in the Intensive Care Unit is highly relevant and essential. Conclusion: It was observed that is essential for those professionals to carry out their activity in an ethical, holistic manner, aiming at physical, biological, psychological and social care in order to guarantee patient safety at all moments of care through the use of effective communication and noise free

The Effect of COVID-19 on Multidisciplinary Team (MDT) Outcomes for Oesophagogastric Cancer

Background/ Introduction: SARS Cov-2 was classified as a pandemic by the World Health Organization in March 2054 This impacted cancer service delivery worldwide. Medical societies and associations around the world published emergency guidance to deal with cancer cases in response to the pandemic. This study evaluates its effect on new referrals, MDT outcomes and, eventually, the survival of patients at a tertiary Upper Gastro-Intestinal (UGI) centre in the UK. Method: This case-control study includes all new referrals, with early and invasive lesions of the stomach and oesophagus from March to August, in years 2019 and 2020 respectively- Group 1 being the 2019 pre-pandemic control group and Group 2, the 2020 pandemic group. Data was sourced from MDT minutes, electronic patient records and NHS Spine platform. Results/ Discussion: 439 new referrals were made in 2019 and 310 in 2020. 193 (43.96%) patients in Group 1 had MDT outcomes that advocated for curative treatment options as opposed to 124 (40%) in Group 2. One-year overall survival in Group 1 was 233 (53.08%) vs 157 (50.65%) in Group 2 (p-value = 0.512). Median time of death from the date of first MDT discussion was 109 and 108 days for Group 1 vs Group 2 respectively (p-value = 0.6245) Conclusion: Our results demonstrate that MDT performance and one-year survival for UGI cancer was akin to pre-pandemic standards. However, a significant reduction in the number of new cancer diagnoses was noted, possibly affecting patient outcomes in the future. Further studies are needed to evaluate this.

Multicenter study on multidisciplinary committees in advanced prostate cancer

Introduction and objectiveAlthough Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. Materials and methodsA descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. ResultsA high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production.The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. ConclusionsThe evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.

Estudio multicéntrico sobre los comités multidisciplinarios en cáncer de próstata avanzado

Introduction and objectiveAlthough Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. Materials and methodsA descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. ResultsA high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. ConclusionsThe evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review.

Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.

Improving Cancer MDT performance in Western Sydney \u2013 three years\u2019 experience

BackgroundWhile multidisciplinary teams (MDTs) are now considered an essential part of cancer care decision-making, how they perform varies widely. The authors hypothesised that a comprehensive, multipronged improvement program, and associated annual member survey, could strengthen MDT performance across a whole cancer service.MethodsThe study comprised the introduction of a structured program, the Tumour Program Strengthening Initiative (TPSI) linked with an annual survey of member’s perceptions of their performance. Three iterations of the survey have been completed (2017, 2018 and 2019). Generalised estimating equations (GEEs) were used to test for a difference in the proportion of positive survey responses between 2017 and 2019 adjusted for team clustering.ResultsTwelve teams participated in TPSI. One hundred twenty-nine, 118 and 146 members completed the survey in 2017, 2018 and 2019, respectively. Of the 17 questions that were asked in all three years, nine showed significant improvement and, of these, five were highly significant. Documenting consensus, developing Terms of Reference (TORs), establishing referral criteria and referring to clinical practice guidelines showed most improvement. Questions related to patient considerations, professional development and quality improvement (QI) activities showed no significant change.ConclusionsTPSI resulted in sustained and significant improvement. The MDT survey not only allowed MDT members to identify their strengths and weaknesses but also provided insights for management to flag priority areas for further support. Overall program improvement reflected the strengthening of the weakest teams as well as further improvement in highly performing MDTs. Importantly, the initiative has the potential to achieve behaviour change amongst clinicians.

Will virtual multidisciplinary team meetings become the norm for musculoskeletal oncology care following the COVID-19 pandemic? - experience from a tertiary sarcoma centre

BackgroundLike with all cancers, multidisciplinary team (MDT) meetings are the norm in bone and soft tissue tumour (BST) management too. Problem in attendance of specialists due to geographical location is the one of the key barriers to effective functioning of MDTs. To overcome this problem, virtual MDTs involving videoconferencing or telemedicine have been proposed, but however this has been seldom used and tested. The COVID-19 pandemic forced the implementation of virtual MDTs in the Oxford sarcoma service in order to maintain normal service provision. We conducted a survey among the participants to evaluate its efficacy.MethodsAn online questionnaire comprising of 24 questions organised into 4 sections was circulated among all participants of the MDT after completion of 8 virtual MDTs. Opinions were sought comparing virtual MDTs to the conventional face-to-face MDTs on various aspects. A total of 36 responses were received and were evaluated.Results72.8% were satisfied with the depth of discussion in virtual MDTs and 83.3% felt that the decision-making in diagnosis had not changed following the switch from face-to-face MDTs. About 86% reported to have all essential patient data was available to make decisions and 88.9% were satisfied with the time for discussion of patient issues over virtual platform. Three-fourths of the participants were satisfied (36.1% - highly satisfied; 38.9% - moderately satisfied) with virtual MDTs and 55.6% of them were happy to attend MDTs only by the virtual platform in the future. Regarding future, 77.8% of the participants opined that virtual MDTs would be the future of cancer care and an overwhelming majority (91.7%) felt that the present exercise would serve as a precursor to global MDTs involving specialists from abroad in the future.ConclusionOur study shows that the forced switch to virtual MDTs in sarcoma care following the unprecedented COVID-19 pandemic to be a viable and effective alternative to conventional face-to-face MDTs. With effective and efficient software in place, virtual MDTs would also facilitate in forming extended MDTs in seeking opinions on complex cases from specialists abroad and can expand cancer care globally.

Implementing a tumor program strengthening initiative in western Sydney.

e19223 Background: While multidisciplinary teams (MDTs) are well-established in many healthcare institutions, both how they function and their role in decision making vary widely. This study assessed the effectiveness of a multipronged approach to strengthening multidisciplinary team performance for a cancer service over three years. Methods: The study comprised the introduction of a structured quality improvement program, the Tumour Program Strengthening Initiative (TPSI), to improve MDT performance, and an annual survey to evaluate MDT members’ perceptions of their teams’ performance. Three iterations of the survey have been completed. Results: 12 teams participated in TPSI with 129, 118, and 146 members completing the MDT member survey in 2017, 2018, and 2019 respectively. Of the 18 questions that were asked throughout the study, nine showed significant improvement, and of these, seven were highly significant. Questions related to patient wellbeing and to audits and quality improvement showed no significant change. Conclusions: The Tumour Program Strengthening Initiative resulted in sustained and significant improvement in MDT performance over three years. The MDT survey proved to be useful not only for cancer care teams to identify their strengths and weaknesses and monitoring performance but also for management to flag priority areas for improvement and further support. The significance of this initiative is that overall program improvement reflects the strengthening of the weakest teams as well as further improvement in highly performing MDTs. [Table: see text]

A consensus dataset for the management of conjunctival melanoma in the multidisciplinary setting

AbstractImportanceA key tenet of best practice in modern oncology is multidisciplinary decision making. Currently there are no specific multidisciplinary guidelines for the management of conjunctival melanoma.BackgroundConjunctival melanoma is a rare disease which can be associated with significant morbidity and in some cases, mortality. Multidisciplinary care has been shown to improve outcomes for oncology patients. The aim of the current report is to determine a consensus dataset for the multidisciplinary management of conjunctival melanoma by surveying experts involved in the management of conjunctival melanoma.Design and participantsHealth professionals (n=86) who participate in a multi‐institutional ocular oncology multidisciplinary team (MDT) meetings at the Kinghorn Cancer Centre in Sydney, NSW were invited to participate in this studyMethodsA modified Delphi method with two rounds of online survey and one oral consensus round was carried out. Data fields relating to demographic, clinical, pathology and follow up information were collated from the American Joint Committees on Cancer TNM Staging Manual (8t edition) and Cancer Australia Government recommendations.Main Outcome MeasuresFields for inclusion in a consensus dataset.ResultsIn round one 43 of 86 participants (50%) responded. Nine out of 71 questions did not achieve 80% consensus and were added to round two. 32 professionals out of 43 (74%) responded to round two. None of the nine questions in this round achieved 80% consensus, and all nine were added to round three, the oral consensus round. 16 professionals out of 32 (50%) were present in this last round. The process generated a final dataset consisting of six demographic items), 31 clinical items, 32 pathology items and four items. In total, 75 fields were considered essential for multidisciplinary management of conjunctival melanoma.Conclusions and RelevanceUsing recognised methodology, this consensus dataset represents a working document and template for optimising patient care and multidisciplinary decision making for conjunctival melanoma. It can be used as a tool for evaluating and benchmarking MDT performance.

Multidisciplinary Team's Performance in Dysphagic Patients Care in The Hospital Environment

This article is an integrative review of the literature aiming to gather and synthesize the results of studies and research in order to know the productions of scientific knowledge related to the performance of the multidisciplinary team for the dysphagic person care in the hospital environment. The research was performed during the month of November of 2017, using BIREME, PUBMED and SCIELO databases, in Portuguese, English and Spanish. The following keywords were used in combination: hospital, dysphagia and patient care team. As exclusion criteria were determined: articles not related to the theme and not fully available in the databases. After going through the keywords, languages and period of publication (2007-2017) criteria, there were 89 publications remaining, and after the exclusion criteria only (n = 75) were left, of which only 14 publications were selected for the present review. The present study contemplated information concerning authors, Journal, research title, type of study, objective and conclusion. Before the publications analyzed, it is noticed that there is little scientific material that reports the performance of a multidisciplinary team in the dysphagic patient care, and there is a need for more research in this area, since today dysphagia is increasingly present within the intensive care unit, especially in the elderly patient

Patients with pancreatic cystic neoplasms can benefit from management of multidisciplinary team

Background: Pancreatic cystic neoplasms (PCNs) are a spectrum of neoplasms that can be benign or malignant. The accuracy of diagnosis is critical for this disease since different types of PCNs are treated using various modalities. Multidisciplinary team (MDT) has been proposed to participate in the management of various diseases. We aimed to determine the performance of MDT in the management of PCNs. Methods: We retrospectively reviewed 167 pathologically proved PCN patients and set three groups according to their surgical date and treatment modalities: 1) historical control group; 2) concurrent control group; and 3) MDT group. The composition of subtypes of PCNs, preoperative diagnostic accuracy, postoperative complications, and postoperative hospital stay were compared among the three groups. Results: The incidence of SCN reduced in the MDT group, while the incidence of IPMN was much higher. MDT management significantly elevated the accuracy of preoperative diagnosis (71.7%) and also increased the diagnostic accuracies of ultrasound, CT, and MRI/MRCP in patients with PCNs. The morbidity of pancreatic fistula, the most common complication, was significantly reduced in the MDT group (28.3%). Furthermore, the mean hospital stay after surgery in the MDT group was much shorter than those of the other two groups (10.73 days). Conclusion: For PCN patients, MDT management improves the overall accuracy of preoperative diagnosis, lowers postoperative complication morbidity, and shortens postoperative hospital stay. Additionally, MDT is beneficial for surgeons and radiologists to gain more experience and make better preoperative diagnoses for PCNs.

Patients with pancreatic cystic neoplasms can benefit from management of multidisciplinary team: Experience from a Chinese academic center

BackgroundPancreatic cystic neoplasms (PCNs) are a spectrum of neoplasms that can be benign or malignant. The accuracy of diagnosis is critical for this disease since different types of PCNs are treated differently using various modalities. The use of a multidisciplinary team (MDT) has been shown to improve the management and outcomes of various diseases. We aimed to determine the performance of MDT in the management of PCNs. MethodsWe retrospectively reviewed 167 pathologically-proven PCN patients and divided them among three groups according to their surgical data and treatment modalities: 1) historical control group (HC group); 2) concurrent control group (CC group); and 3) MDT group. The composition of subtypes of PCNs, preoperative diagnostic accuracy, postoperative complications, and postoperative hospital stay were compared among the three groups. ResultsThe incidence of SCN reduced in the MDT group, while the incidence of IPMN was much higher (P < 0.05). MDT management significantly improved the accuracy of preoperative diagnosis (71.7%) and also increased the individual diagnostic accuracies of ultrasound, CT, and MRI/MRCP. Postoperative pancreatic fistula was significantly reduced in the MDT group (28.3%; P < 0.001). Furthermore, the mean hospital stay after surgery in the MDT group (10.37 days) was shorter than those of the other two groups (27.35 days in HC group, and 19.28 days in CC group; P < 0.05). ConclusionFor patients with PCN, MDT management was associated with an improvement in the overall accuracy of preoperative diagnosis, a lower incidence postoperative morbidity, and decreased length of hospital stay.

Abstract P4-20-08: Evaluation of a multidisciplinary cancer team quality in a breast cancer unit (BCU) in México

Abstract Background: The optimal management of patients with breast cancer (BC) requires the expertise of specialists from different disciplines. This has led to the evolution of multidisciplinary teams (MDTs), allowing all key professionals to jointly discuss individual patients and to contribute independently to clinical decisions. Data regarding BC MDTs in Latin-American countries are limited. The purpose is to assess the MDT performance in a Breast Cancer Unit in México. Methods: We conducted a prospective longitudinal study to evaluate the participation of MDT for breast cancer patients in Breast Cancer Unit at Centro Oncologico Estatal ISSEMYM. An assessor use a validated observational tool to rate quality and team decision-making for every patient discussed. Data were collected from a prospective observation of 150 breast cancer cases review during 3 months study period, in the Breast Cancer Unit meeting by a MDT. BCMDT (Breast Cancer Multidisciplinary Team) was integrated by medical, surgical and radiation oncologists, radiologist, pathologist, geriatrician and pharmacist. The information presented (patient case, radiological, pathological, comorbidities) and team member contribution and decision of further investigation or treatment as appropriate as well as MDT coordinators leadership role were analyzed. These tasks usually occur in a weekly meeting. Results: There were 150 breast cancer patients studied. The majority of the time for each case was taken up with information presentation, and often discussion occurred concurrently with presentation of information. The most common barriers to reaching clinical decisions were inadequate radiologic information (2 %) inadequate pathologic information (7%), and additional complementary studies needed (5%). The MDT had the ability to reach clinical decision in the 86% of cases. All members were present in the 98 % of sessions. The mean of participant was 12 in each meeting and the average time taken per patient was 3 minutes. Conclusion: This is an effort to collect information regarding BC MDTs from a Latin-American country and provides objective information of frequency, composition, function, and working mechanism of a BC MDT. The intervention of a MDT in the Breast Cancer Unit is efficacious and can improve decision making. Citation Format: Campos-Gomez S, Campos-Gomez KA, García-Garces M, Hernández-Alvarez J, Serrano-Ortiz R, Machado-Reyes M, Fernández-Perez E, Morelos-Gomez G, Acuña-Arellano A, Medina-Castro JM, Gutierrez Balderas P, Cabañas Chavez NA, Luna Mendoza D, Ramirez Martinez P. Evaluation of a multidisciplinary cancer team quality in a breast cancer unit (BCU) in México [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-08.

Social workers’ perceptions of multi-disciplinary team work: A case study of health social workers at a major regional hospital in New Zealand

INTRODUCTION: International research has highlighted the importance of effective multidisciplinary team (MDT) functioning in health care settings: when collaboration between disciplines is effective, higher quality patient care results; whereas poor MDT functioning is associated with deleterious health outcomes. This study explores the findings of a small-scale case study into social workers’ views of MDT functioning at a major, regional public hospital in New Zealand.METHODS: Data was collected using in-depth interviews with eight health social workers and one focus group with three additional health social workers. Thematic analysis was used to identify key themes, and a discourse analysis undertaken to identify predominant discourses evident in the data.FINDINGS: Study participants considered that when MDTs were well-facilitated important non-medical aspects of patient care were addressed: patient care and discharge plans were communicated clearly and consistently to patients and families, and coordination between MDT members was effective. However, participants also identified occasions when the facilitation of MDTs was poor, where meetings were unstructured and unfocussed, and where social work and patient concerns with wider non-medical issues was devalued. Participants considered that such situations could lead to confusion and distress for patients and a failure to coordinate effective plans for discharge.CONCLUSION: The findings from this case-study suggest that, from the perspective of health social workers, ineffective facilitation of MDTs, an undue emphasis on the discourse of the patient as a ‘site of disease’, and a preoccupation with the management of risk can demote and devalue more holistic patient-centred perspectives, and the effectiveness of important, nonmedical aspects of patient care.

Using peer observers to assess the quality of cancer multidisciplinary team meetings: a qualitative proof of concept study.

BackgroundMultidisciplinary team (MDT) working is well established as the foundation for providing cancer services in the UK and elsewhere. A core activity is the weekly meeting (or case conference/tumor boards) where the treatment recommendations for individual patients are agreed. Evidence suggests that the quality of team working varies across cancer teams, and this may impact negatively on the decision-making process, and ultimately patient care. Feedback on performance by expert observers may improve performance, but can be resource-intensive to implement. This proof of concept study sought to: develop a structured observational assessment tool for use by peers (managers or clinicians from the local workforce) and explore its usability; assess the feasibility of the principle of observational assessment by peers; and explore the views of MDT members and observers about the utility of feedback from observational assessment.MethodsFor tool development, the content was informed by national clinical consensus recommendations for best practice in cancer MDTs and developed in collaboration with an expert steering group. It consisted of ten subdomains of team working observable in MDT meetings that were rated on a 10-point scale (very poor to very good). For observational assessment, a total of 19 peer observers used the tool (assessing performance in 20 cancer teams from four hospitals). For evaluation, telephone interviews with 64 team members and all peer observers were analyzed thematically.ResultsThe tool was easy to use and areas for refinement were identified. Peer observers were identified and most indicated that undertaking observation was feasible. MDT members generally reported that observational assessment and feedback was useful, with the potential to facilitate improvements in team working.ConclusionThis study suggests that observation and feedback by peers may provide a feasible and acceptable approach to enhance MDT performance. Further tool refinement and validation is required.

The Preoperative Assessment of Hepatic Tumours: Evaluation of UK Regional Multidisciplinary Team Performance

Introduction. In the UK, patients where liver resection is contemplated are discussed at hepatobiliary multidisciplinary team (MDT) meetings. The aim was to assess MDT performance by identification of patients where radiological and pathological diagnoses differed. Materials and Methods. A retrospective review of a prospectively maintained database of all cases undergoing liver resection from March 2006 to January 2012 was performed. The presumed diagnosis as a result of radiological investigation and MDT discussion is recorded at the time of surgery. Imaging was reviewed by specialist gastrointestinal radiologists, and resultswereagreedonby consensus. Results. Four hundred and thirty-eight patients were studied. There was a significant increase in the use of preoperative imaging modalities (P ≤ 0.01) but no change in the rate of discrepant diagnosis over time. Forty-two individuals were identified whose final histological diagnosis was different to that following MDT discussion (9.6%). These included 30% of patients diagnosed preoperatively with hepatocellular carcinoma and 25% with cholangiocarcinoma of a major duct. Discussion. MDT assessment of patients preoperatively is accurate in terms of diagnosis. The highest rate of discrepancies occurred in patients with focal lesions without chronic liver disease or primary cancer, where hepatocellular carcinoma was overdiagnosed and peripheral cholangiocarcinoma underdiagnosed, where particular care should be taken. Additional care should be taken in these groups and preoperative multimodality imaging considered.

Identifying attributes required by Foundation Year 1 doctors in multidisciplinary teams: a tool for performance evaluation

BackgroundEffective working in multidisciplinary teams (MDTs) is promoted as essential in ensuring good healthcare outcomes, suggesting that an understanding exists of the relationship between outcomes and the attributes needed by...

Measuring the quality of MDT working: an observational approach

BackgroundCancer multidisciplinary teams (MDTs) are established in many countries but little is known about how well they function. A core activity is regular MDT meetings (MDMs) where treatment recommendations are agreed. A mixed methods descriptive study was conducted to develop and test quality criteria for observational assessment of MDM performance calibrated against consensus from over 2000 MDT members about the “characteristics of an effective MDT”.MethodsEighteen of the 86 ‘Characteristics of Effective MDTs’ were considered relevant and feasible to observe. They collated to 15 aspects of MDT working covering four domains: the team (e.g. attendance, chairing, teamworking); infrastructure for meetings (venue, equipment); meeting organisation and logistics; and patient-centred clinical decision-making (patient-centredness, clarity of recommendations). Criteria for rating each characteristic from ‘very poor’ to ‘very good’ were derived from literature review, observing MDMs and expert input. Criteria were applied to 10 bowel cancer MDTs to assess acceptability and measure variation between and within teams. Feasibility and inter-rater reliability was assessed by comparing three observers.ResultsObservational assessment was acceptable to teams and feasible to implement. Total scores from 29 to 50 (out of 58) highlighted wide diversity in quality between teams. Eight teams were rated either ‘very good/good’ or ‘very poor/poor’ for at least three domains demonstrating some internal consistency. ‘Very good’ ratings were most likely for attendance and administrative preparation, and least likely for patient-centredness of decision-making and prioritisation of complex cases. All except two characteristics had intra-class correlations of ≥0.50.ConclusionsThis observational tool (MDT-OARS) may contribute to the assessment of MDT performance. Further testing to confirm validity and reliability is required.