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Background:
Multidisciplinary team (MDT) meetings provide treatment recommendations based on available information and collective decision-making in teams with complementary professions, disciplines and skills. We aimed to map ancillary medical and nonmedical patient information during case presentations and case discussions in MDT meetings in can...
Contexts in source publication
Context 1
... preferences were reported in 4.2% of the cases. In 11.3% of the cases, valuations were given and were positive in 8.6% and negative in 2.7%, with examples provided in Table 2. The patient is "semi-functional" Feeling great, works 150%, good-looking Information on medical factors, physical status, psychologic status and comorbidity did not correlate with age or sex ( Figure 1, Table S1). ...Context 2
... identification of valuation in 11.3% of the case discussions should in our opinion alert the MDT teams to the background and rationale for providing such statements as exemplified in Table 2. The identification of positive and negative valuations in 8.6% and 2.7% of the cases, respectively, is comparable to observations from France. ...Citations
... Improved uptake could be achieved by educating internal and external referrers about the MDT's needs and expectations, for example by sending back incomplete referrals with a request for further information prior to the MDTM, however this is a resource intensive process that may, in the short term, be detrimental to patient care. Studies of MDTs for different tumour types within the UK 21 and internationally [22][23][24] found that the quality of information provided in meetings impacts the likelihood of a decision being made and this also varied in the observed MDTMs. Agreeing a minimum dataset for a case to be discussed in a MDTM, as developed for lung MDTs in Australia, 23 and improving the transfer of this information, via MDTM agenda or case presentation, is likely to support more efficient and effective decision-making in MDTMs. ...
Background:
Multidisciplinary team meetings (MDTMs), where treatment recommendations are discussed and agreed, are fundamental to effective cancer care. The increasing volume and complexity of caseloads has led to the need to transform MDTM pathways to improve efficiency and allow sufficient time for discussion of complex cases. Understanding of current functioning and inefficiencies is required to inform such transformation.
Methods:
A mixed-methods observational study of all lung cancer MDTMs in one UK cancer network over 12 weeks (n = 8 MDTs, 96 MDT meetings). Data were collected on meeting attendance and on each discussed case using a validated MDT tool. Semi-structured interviews were conducted with a range of MDT members and cancer service managers to gain understanding of perceived influences on the efficiency of MDTMs.
Results:
In total, 1671 case discussions were observed. Models of MDT working, including referral and diagnostic pathway management, varied within the network. Attendance was quorate in only 21% of the observed MDTMs, most often lacking palliative care specialists. Over a third (37%) of observed cases were repeat discussions pre-diagnosis. Treatment recommendations were agreed in 48% of case discussions but deferred for a quarter (24%) of discussed cases, most commonly due to awaiting results. Information about patients' fitness for treatment and/or performance status score was available for 60% of cases discussed overall (30%-75% by MDT). Interviews (n = 56) identified addressing clinical and administrative workforce shortages, less reliance on the MDTM for pre-diagnostic decision-making and better availability of key clinical information about patients discussed in the MDTM as factors critical to improved MDT function.
Conclusions:
Inefficiencies were prevalent in all MDTMs; improvements would require an individualised approach due to the variation in ways of working. Local, regional and national support is needed for lung MDTs to develop their diagnostic workforce and facilities, and clinical and administrative resource.
... Data on psychological status, comorbidities, and patients' and family wishes and preferences could not be reported from the recent study. Wihl et al (21) also reported that psychological factors, nonmedical factors such as family relations, occupation, country of origin and patient preference were referred to in less than 10% of cases in MDT discussions. Therefore, there is a need to de ne data elements and develop reporting standards for MDTM to support MDTM decision-making. ...
Background
Nasopharyngeal cancer (NPC) is a common cancer in Asia. In many developing countries, most cases are in advanced stages, compromising the outcome of treatment. The complexity of NPC management for advanced-stage NPC requires thorough communication and shared clinical decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate clinical collaboration and communication between physicians. This recent study aimed to compare quality of care, clinical responses and survival between NPC patients treated inside and outside of MDTM care.
Methods
This was a retrospective study comparing NPC patients treated under the MDTM with NPC patients managed outsidethe MDTM. Clinical responses, assessment visits, date of progression and date of death were collected. Data were analyzed with X2 for discrete variables and t tests for continuous variables. Kaplan‒Meier survival curves with log-rank tests were used to describe the difference in survival estimation between the groups. Cox regression hazard models were calculated to predict the hazard risk for progression and survival. Significance was determined as p < 0.05.
Results
There were 87 patients treated under MDTM and 178 patients treated outside MDTM. Histology type of WHO type 3 was predominant. Stages IVA and B accounted for more than 60% of patients. Revision of diagnosis during MDTM accounted for 5.7%, and revision of stage occurred in 52.9%of cases. More clinical responses were achieved by patients treated under MDTM than by patients outside MDTM (69.0% vs. 32.0%, p < 0.00). The median progression-free survival of NPC patients under MDTM was 59.89 months compared with 12.68 months outside MDTM (log rank p < 0.00). Overall survival was longer in patients treated under MDTM compared with patients outside MDT (not reached vs. 13.44 months; p < 0.00). NPC patients who received treatment recommendations from the MDTM had a lower risk for progression (HR 0.267, 95% CI 0.17-0.40, p < 0.00) and mortality (HR 0.134; 95% CI 0.08 -0.24, p < 0.00).
Conclusion
Incorporating the MDTM approach into NPC management improves the clinical response and survival of patients.
... In the context of MDTMs, consideration of information concerning the patient perspective in clinical decision-making is multifaceted [9]. The patient perspective can include information about non-medical characteristics such as age, psychological aspects, and social factors such as family relations, profession, and preferences [10], but can also include medical information on comorbidity and physical status [11]. Several studies report that in MDTMs the biomedical perspective dominates, and less attention is given to the patient perspective [4,6,7,[12][13][14]. ...
... This can partly be explained by a lack of strategies to collect this information before MDTMs [14]. However, limited information on the patient perspective in MDTMs may constitute a barrier to individualized treatment recommendations [13,15,16], resulting in difficulties implementing the recommendation after the MDTM [9,11,17,18]. At the same time, it is unclear what benefits patients the most: their perspective being included in the decision-making process, or the MDT conducting a fact-based discussion before considering patient preferences [9]. ...
Background
Multidisciplinary team meetings (MDTMs) represent an integral component of modern cancer care and have increasingly been implemented to ensure accurate and evidence-based treatment recommendations. During MDTMs, multiple and complex medical and patient-related information should be considered by a multi-professional team whose members contribute various perspectives. Registered nurses (RNs) are expected to share information on the patient perspective at MDTMs. However, research suggests that RNs’ contributions to case discussions are limited and that patient perspective is generally underrepresented. Our aim was to explore RNs’ views of the prerequisites for and barriers to the inclusion of the patient perspective in MDTMs in Swedish cancer care.
Methods
Data were collected from four focus group interviews with 22 RNs who worked as contact nurses in Swedish cancer care. Interviews were transcribed and analysed using inductive content analysis.
Results
The analysis identified two categories and five subcategories. The participants presented different views and expressed ambivalence about the patient perspective in MDTMs. Subcategories were related to medical versus holistic perspectives, the added value of patient perspective, and possibilities for patient contributions. The participants also discussed prerequisites for the patient perspective to be considered in MDTM decision-making process, with subcategories related to structures promoting attention to the patient perspective and determinants of RNs’ contributions to case discussions in MDTMs.
Conclusions
This study demonstrates various views related to the patient perspective in MDTMs and identifies a great need to clarify the RN’s role. Our results indicate that if enhanced presentation of the patient perspective in MDTMs is desired, key information points and structures must be established to collect and present relevant patient-related information.
... In 5% of the cases discussed at general or tumour-specific MDTMs, pathology or radiology results were absent [64]. Inadequate or absent information about radiology and pathology results proved to be a barrier to making clinical decisions within the MDTM, as was a lack of up-to-date information about the patients' comorbidities and condition [31,45,54,55,71,78,89]. According to two interview studies, imaging technology and real-time data support and enhance clinical discussion during MDTMs [47,70]. ...
... When comparing observation with a self-assessment tool, case histories and radiological information were best presented and patients' views and comorbidities/psychosocial issues were least well presented in a study involving 164 cancer patients and 67 team members in 5 MDTMs [52]. Other studies reported similar findings, all concluding a lack of patient centeredness in terms of available information on comorbidities and preferences [19,21,38,45,73,79,89]. A large survey including 1636 MDT members recommended a crucial role for the CNS in representing patient preferences [56]. ...
Background
Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement.
Methods
Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author.
Results
Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs.
Conclusions
MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
... Lack of information regarding patients' comorbidities or wishes also occurs in tumor board meetings (Abukar et al. 2018;Bolle et al. 2019;Lamb et al. 2013;Wihl et al. 2021). In our study, patient comorbidities caused 24% of tumor board deviations and an ECOG-PS ≥ 2 was significantly associated with lower tumor board adherence (P < 0.05). ...
... In our study, patient comorbidities caused 24% of tumor board deviations and an ECOG-PS ≥ 2 was significantly associated with lower tumor board adherence (P < 0.05). Currently, there is neither a gold standard for comorbidity measurement in oncological patients nor a standard regarding patient-specific data that is required to make robust treatment recommendations in tumor boards (Sarfati 2012;Wihl et al. 2021). Furthermore, this may prevent MTB participants from making treatment decisions and from fully implementing them (Blazeby et al. 2006;Jalil et al. 2013;Wood et al. 2008). ...
Purpose
Although participation in multidisciplinary tumor boards (MTBs) is an obligatory quality criterion for certification, there is scarce evidence, whether MTB recommendations are consistent with consensus guidelines and whether they are followed in clinical practice. Reasons of guideline and tumor board deviations are poorly understood so far.
Methods
MTB’s recommendations from the weekly MTB for gastrointestinal cancers at the University Cancer Center Leipzig/Germany (UCCL) in 2020 were analyzed for their adherence to therapy recommendations as stated in National German guidelines and implementation within an observation period of 3 months. To assess adherence, an objective classification system was developed assigning a degree of guideline and tumor board adherence to each MTB case. For cases with deviations, underlying causes and influencing factors were investigated and categorized.
Results
76% of MTBs were fully adherent to guidelines, with 16% showing deviations, mainly due to study inclusions and patient comorbidities. Guideline adherence in 8% of case discussions could not be determined, especially because there was no underlying guideline recommendation for the specific topic. Full implementation of the MTBs treatment recommendation occurred in 64% of all cases, while 21% showed deviations with primarily reasons of comorbidities and differing patient wishes. Significantly lower guideline and tumor board adherences were demonstrated in patients with reduced performance status (ECOG-PS ≥ 2) and for palliative intended therapy ( p = 0.002/0.007).
Conclusions
The assessment of guideline deviations and adherence to MTB decisions by a systematic and objective quality assessment tool could become a meaningful quality criterion for cancer centers in Germany.
... In our study, patient comorbidities caused 24% of tumor boarddeviations and an ECOG-PS ≥ 2 was signi cantly associated with lower tumor board adherence (p < .05). Currently, there is neither a gold standard for comorbidity measurement in oncological patients nor a standard regarding patient-speci c data that is required to make robust treatment recommendations in tumor boards(Sarfati 2012;Wihl et al. 2021). Further, this may prevent MTB participants from making treatment decisions and from fully implementing them(Blazeby et al. 2006;Jalil et al. 2013;Wood et al. ...
Purpose: Although participation in multidisciplinary tumor boards (MTBs) is an obligatory quality criterion for certification, there is scarce evidence, whether MTB recommendations are consistent with consensus guidelines and whether they are followed in clinical practice. Reasons of guideline and tumor board deviations are poorly understood so far.
Methods: MTBs recommendations from the weekly MTB for gastrointestinal cancers at the University Cancer Center Leipzig/Germany (UCCL) in 2020 were analyzed for their adherence to therapy recommendations as stated in National German guidelines and implementation within an observation period of 3 months. To assess adherence, an objective classification system was developed assigning a degree of guideline and tumor board adherence to each MTB case. For cases with deviations, underlying causes and influencing factors were investigated and categorized.
Results: 76% of MTBs were fully adherent to guidelines, with 16% showing deviations, mainly due to study inclusions and patient comorbidities. Guideline adherence in 8% of case discussions could not be determined, especially because there was no underlying guideline recommendation for the specific topic. Full implementation of the MTBs treatment recommendation occurred in 64% of all cases, while 21% showed deviations with primarily reasons of comorbidities and differing patient wishes. Significantly lower guideline and tumor board adherences were demonstrated in patients with reduced performance status (ECOG-PS ≥ 2) and for palliative intended therapy (p=.002/.007).
Conclusion: The assessment of guideline deviations and adherence to MTB decisions by a systematic and objective quality assessment tool could become a meaningful quality criterion for cancer centers in Germany.
... Accurate assessment of surgical indications and tumor characteristics requires an MDT of specialists with different expertise from different departments. 9 In addition, the underlying basic disease conditions as well as patient preferences should also be given consideration. The MDT model, utilizing all available data, evidence-based recommendation, and expert opinions from different specialties for optimal patient assessment as well as comprehensive clinical management, is beneficial to gastric cancer patients. ...
Gastric cancer is a heterogeneous disease which requires a multimodal approach of management. The Department of Gastrointestinal Surgery at Changhai Hospital, a tertiary hospital in Shanghai, established the gastric cancer multidisciplinary team (MDT) clinic based on the guidance of MDT culture in the year of 2017. Our MDT discussion followed a weekly consultation model, with the full-board discussion held once a month, and mini-board communication and discussion made once a week. The stages of MDT management are: pre-operative treatment plan and preparation, post-operative treatment plan, and follow-up treatment and evaluation. As of March 2021, a total of 296 patients visited the MDT clinic. Majority of the patients were gastric carcinoma patients (273/296, 92.2%). Here, we shared our gastric cancer MDT experiences and summarized our strengths and proposed directions for improvement.
Multidisciplinary teams (MDTs) are common in colorectal cancer and have been deemed important when providing care. Yet they take place outside of the patient, often with little consideration of the patient's views, goals and desires. In this paper specific examples from a patient perspective are integrated with the social science literature to provide an overview of areas of disconnect between MDT recommendations and the individual patient. The reasons for these disconnects are explored, including how MDTs relate to dyadic patient–clinician relationships, weak incorporation of patient‐oriented outcomes in MDTs, poor integration of nonmedical patient information and the patient perspective and the impact of team dynamics and cognitive decision biases. Consideration of these issues should facilitate higher‐quality MDT recommendations that are also more acceptable to patients.
Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients’ clinical responses and survival.
Objective:
To investigate decision making for patients with advanced ovarian cancer as a possible explanation of geographical variation in treatment patterns.
Methods:
We carried out a multi-centre observational study in multidisciplinary teams meetings for five major UK cancer centres. All patients presenting to five cancer centres with advanced ovarian cancer over a six-week period. The GO-MDT-MODe tool was used to provide a measure of participation and quality of case discussion for all cases of advanced ovarian cancer. MDT scores were correlated with surgical data extracted from national audit data. Data were recorded for overall MDT performance.
Results:
A total of 870 case discussions, including 145 cases of advanced ovarian cancer, were observed. MDTs varied in structure, format and time allocation between centres. Cluster analysis showed significant variation in quality and participation of discussion between centres (p < 0.0025) and this correlated with the proportion of patients in the wider cancer alliance undergoing surgery.
Conclusions:
We have shown that at least part of the variation in practice seen in the UK correlates with different behaviours within MDTs. Increasing time for discussion and encouraging participation from all staff groups may increase proportions of patients undergoing optimal treatment regimens.
