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Balachandran A, Duckett J. What is the role of the multidisciplinary team in the management of urinary incontinence? Int Urogynecol J 2014; 26:791-3. [PMID: 25416023 DOI: 10.1007/s00192-014-2579-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Multidisciplinary teams (MDT) are a well-established part of service provision and clinical care in the UK. In 2013, the National Institute for Health and Care Excellence (NICE) Urinary Incontinence guideline recommended that MDT review should be mandatory before invasive therapy is offered to all patients with stress urinary incontinence (SUI) and overactive bladder (OAB). Currently, there is no evidence in the literature regarding the use of MDTs in urogynaecology. The aim of this paper is to assess the potential benefits and disadvantages of the creation of routine MDT meetings for the management of urinary incontinence.
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Affiliation(s)
- Aswini Balachandran
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK,
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102
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Taylor C, Finnegan-John J, Green JSA. "No decision about me without me" in the context of cancer multidisciplinary team meetings: a qualitative interview study. BMC Health Serv Res 2014; 14:488. [PMID: 25339192 PMCID: PMC4210563 DOI: 10.1186/s12913-014-0488-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background Cancer care is commonly managed by multidisciplinary teams (MDTs) who meet to discuss and agree treatment for individual patients. Patients do not attend MDT meetings but recommendations for treatments made in the meetings directly influence the decision-making process between patients and their responsible clinician. No research to-date has considered patient perspectives (or understanding) regarding MDTs or MDT meetings, though research has shown that failure to consider patient-based information can lead to recommendations that are inappropriate or unacceptable, and can consequently delay treatment. Methods Semi-structured interviews were conducted with current cancer patients from one cancer centre who had either upper gastrointestinal or gynaecological cancer (n = 9) and with MDT members (n = 12) from the teams managing their care. Interview transcripts were analysed thematically using Framework approach. Key themes were identified and commonalities and discrepancies within and between individual transcripts and within and between patient and team member samples were identified and examined using the constant comparative method. Results Patients had limited opportunities to input to or influence the decision-making process in MDT meetings. Key explanatory factors included that patients were given limited and inconsistent information about MDTs and MDT meetings, and that MDT members had variable definitions of patient-centredness in the context of MDTs and MDT meetings. Patients that had knowledge of medicine (through current/previous employment themselves or that of a close family member) appeared to have greater understanding and access to the MDT. Reassurance emerged as a ‘benefit’ of informing patients about MDTs and MDT meetings. Conclusions There is a need to ensure MDT processes are both efficient and patient-centred. The operationalization of “No decision about me without me” in the context of MDT models of care – where patients are not present when recommendations for treatment are discussed - requires further consideration. Methods for ensuring that patients are actively integrated into the MDT processes are required to ensure patients have an informed choice regarding engagement, and to ensure recommendations are based on the best available patient-based and clinical evidence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0488-2) contains supplementary material, which is available to authorized users.
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Schwappach DLB, Gehring K. Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study. Eur J Cancer Care (Engl) 2014; 24:395-403. [PMID: 25287114 DOI: 10.1111/ecc.12255] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/28/2022]
Abstract
Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer.
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Affiliation(s)
- D L B Schwappach
- Swiss Patient Safety Foundation, Zuerich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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104
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Ansmann L, Kowalski C, Pfaff H, Wuerstlein R, Wirtz MA, Ernstmann N. Patient participation in multidisciplinary tumor conferences. Breast 2014; 23:865-9. [PMID: 25301777 DOI: 10.1016/j.breast.2014.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/22/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To identify (1) how frequently patients are invited to take part and actually do take part in multidisciplinary tumor conferences (MTCs), (2) which patient characteristics affect whether they are invited to MTCs and whether they decide to participate, (3) the extent to which invitation and participation depend on the specific hospital. STUDY DESIGN Survey data from 4146 newly-diagnosed breast cancer patients treated in 83 hospitals in North Rhine-Westphalia, Germany, were analyzed using multilevel modeling. RESULTS 12% of the patients were offered participation in the MTC. More than half of these patients actually participated. Invitations to participate differed by patients' sociodemographic, disease, and treatment characteristics, whereas decisions to participate were largely independent of these characteristics. Invitation and participation are strongly dependent on the specific hospital. CONCLUSION The practice of inviting cancer patients to MTCs requires further research, particularly on benefits and disadvantages for patients and ways of organizing MTCs.
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Affiliation(s)
- Lena Ansmann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany.
| | - Christoph Kowalski
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany.
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany.
| | - Rachel Wuerstlein
- Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Markus Antonius Wirtz
- Institute of Psychology, University of Education Freiburg, Kunzenweg 21, 79117 Freiburg, Germany.
| | - Nicole Ernstmann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany.
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Jalil R, Akhter W, Lamb BW, Taylor C, Harris J, Green JS, Sevdalis N. Validation of Team Performance Assessment of Multidisciplinary Tumor Boards. J Urol 2014; 192:891-8. [DOI: 10.1016/j.juro.2014.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Rozh Jalil
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Whipps Cross University Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Waseem Akhter
- Whipps Cross University Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Benjamin W. Lamb
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Urology, Lister Hospital, London, United Kingdom
| | - Cath Taylor
- King's College London, London, United Kingdom
| | | | - James S.A. Green
- Whipps Cross University Hospital, Barts Health National Health Service Trust, London, United Kingdom
- Department of Health and Social Care, London Southbank University, London, United Kingdom
| | - Nick Sevdalis
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Brar SS, Hong NL, Wright FC. Multidisciplinary cancer care: does it improve outcomes? J Surg Oncol 2014; 110:494-9. [PMID: 24986235 DOI: 10.1002/jso.23700] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/22/2014] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care has been advocated as a solution for increasingly complex treatment decisions in cancer patients. The impact of multidisciplinary care on patient survival has been studied, but evidence is limited by poor methodological quality. Lack of conclusive evidence for increased survival is balanced against improvements in quality of care, guideline adherence, reduction in wait times, and greater satisfaction for patients and care providers.
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Affiliation(s)
- Savtaj S Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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107
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Bensenhaver J, Winchester DP. Surgical Leadership and Standardization of Multidisciplinary Breast Cancer Care. Surg Oncol Clin N Am 2014; 23:609-16. [DOI: 10.1016/j.soc.2014.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sarkar S, Arora S, Lamb BW, Green JSA, Sevdalis N, Darzi A. Case review in urology multidisciplinary team meetings: What members think of its functioning. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814532459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To improve communication and decision making between specialists, multidisciplinary teams (MDTs) were introduced with the premise they would improve cancer care for patients. Minimal evidence exists on MDT functionality. We investigated MDT members’ views on barriers to optimal functioning and explored their suggestions for improvements. Materials and methods: Twenty urology MDT members from seven hospitals including surgeons, oncologists, pathologists, radiologists and clinical nurse specialists took part in a semi-structured interview study. Interviews focused on information presentation, case discussion, factors affecting the multidisciplinary team meeting (MDM) and potential improvements. Interviews were transcribed and analysed through emergent theme analysis. Results: Factors negatively influencing the MDMs included insufficient time to prepare cases so that enough information is available to make appropriate decisions; absence of the clinician in charge or not knowing the patient; and lack of a systematic approach to case discussion. Recommendations included protected time for case preparation, focusing on performance and comorbidities of the patient, standardising the MDT meeting and improving case selection. Conclusions: MDTs in urology have contributed to advances in cancer care but there is significant scope for further improvement. Implementing recommendations from team members on the front line may help drive quality in this sensitive domain.
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Affiliation(s)
- Somita Sarkar
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Sonal Arora
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
- Whipps Cross University Hospital, UK
| | - James SA Green
- Whipps Cross University Hospital, UK
- Faculty of Health and Social Care, London South Bank University, UK
| | - Nick Sevdalis
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
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110
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Gagliardi AR, Stuart-McEwan T, Gilbert J, Wright FC, Hoch J, Brouwers MC, Dobrow MJ, Waddell TK, McCready DR. How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer? Implement Sci 2014; 9:4. [PMID: 24383742 PMCID: PMC3884012 DOI: 10.1186/1748-5908-9-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes. METHODS A case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis. DISCUSSION Findings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Research Institute, University Health Network, Toronto, Canada.
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111
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Yopp AC, Mansour JC, Beg MS, Arenas J, Trimmer C, Reddick M, Pedrosa I, Khatri G, Yakoo T, Meyer JJ, Shaw J, Marrero JA, Singal AG. Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome. Ann Surg Oncol 2013; 21:1287-95. [PMID: 24318095 DOI: 10.1245/s10434-013-3413-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate differences in overall survival in patients with hepatocellular carcinoma (HCC) after the establishment of a multidisciplinary clinic (MDC) for HCC. METHODS Patient demographic and tumor characteristics of 355 patients diagnosed with HCC were collected between October 2006 and September 2011. Patients diagnosed after the initiation of the HCC MDC on October 1, 2010, were compared to patients diagnosed in the 4 years before. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the groups. RESULTS A total of 105 patients were diagnosed in the time period after HCC MDC initiation compared to 250 patients in the previous 4 years. Patients diagnosed with HCC after the HCC MDC had fewer symptoms at presentation (64 vs. 78 %, p = 0.01) and earlier stage of tumor presentation [Barcelona Clinic for Liver Cancer (BCLC) A stage, 44 vs. 26 %, p = 0.0003; tumor, node, metastasis classification system stage 1, 44 vs. 30 %, p = 0.003) compared with patients diagnosed before MDC formation. The median time to treatment after diagnosis in the later period was significantly shorter than in the earlier time period (2.3 vs. 5.3 months, p = 0.002). On multivariate analysis, being seen in the HCC MDC remained independently associated with better overall survival (hazard ratio 2.5, 95 % confidence interval 2-3), after adjusting for BCLC stage and recipient of curative treatment. Patients diagnosed after HCC MDC initiation had a median survival of 13.2 months compared to the 4.8 months observed in patients diagnosed before MDC formation (p = 0.005). CONCLUSIONS The implementation of a MDC for the evaluation and treatment of patients with HCC is associated with improved overall survival.
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Affiliation(s)
- Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA,
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van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A, Loneragan R, McCaughan B, Boyer M, Feigen M, Currow D, Schofield P, Nick Pavlakis BI, McLean J, Marshall H, Leong S, Keena V, Penman A. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5:E254-307. [PMID: 24416529 PMCID: PMC3886874 DOI: 10.3978/j.issn.2072-1439.2013.11.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/24/2022]
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113
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Brar SS, Provvidenza C, Hunter A, Victor JC, Irish JC, McLeod RS, Wright FC. Improving Multidisciplinary Cancer Conferences: A Population-Based Intervention. Ann Surg Oncol 2013; 21:16-21. [DOI: 10.1245/s10434-013-3296-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 12/24/2022]
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Taylor C, Shewbridge A, Harris J, Green JS. Benefits of multidisciplinary teamwork in the management of breast cancer. BREAST CANCER-TARGETS AND THERAPY 2013; 5:79-85. [PMID: 24648761 PMCID: PMC3929250 DOI: 10.2147/bctt.s35581] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The widespread introduction of multidisciplinary team (MDT)-work for breast cancer management has in part evolved due to the increasing complexity of diagnostic and treatment decision-making. An MDT approach aims to bring together the range of specialists required to discuss and agree treatment recommendations and ongoing management for individual patients. MDTs are resource-intensive yet we lack strong (randomized controlled trial) evidence of their effectiveness. Clinical consensus is generally favorable on the benefits of effective specialist MDT-work. Many studies have shown the benefits of receiving treatment from a specialist center, and evidence continues to accrue from comparative studies of clinical benefits of an MDT approach, including improved survival. Patients’ views of the MDT model of decision-making (and in particular its impact on involvement in decisions about their care) have been under-researched. Barriers to effective teamwork and poor decision-making include excessive caseload, low attendance at meetings, lack of leadership, poor communication, role ambiguity, and failure to consider patients’ holistic needs. Breast cancer nurses have a key role in relation to assessing holistic needs, and their specialist contribution has also been associated with improved patient experience and quality of life. This paper examines the evidence for the benefits of MDT-work, in particular for breast cancer. Evidence is considered within a context of growing cancer incidence at a time of increased financial restraint, and it may now be important to reevaluate the structure and models of MDT-work to ensure that MDTs are an efficient use of resources.
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Affiliation(s)
- Cath Taylor
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - Amanda Shewbridge
- Breast Cancer Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jenny Harris
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - James S Green
- Department of Urology, Barts Health NHS Trust, London, UK ; Department of Health and Social Care, London South Bank University, London, UK
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Lamb BW, Green JSA, Benn J, Brown KF, Vincent CA, Sevdalis N. Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients. J Am Coll Surg 2013; 217:412-20. [PMID: 23891067 DOI: 10.1016/j.jamcollsurg.2013.04.035] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions. STUDY DESIGN We conducted a prospective longitudinal study during 16 months that evaluated MTB decision making for urological cancer patients at a university hospital in London, UK. After a baseline period, MTB improvement interventions (eg, MTBs checklist, MTB team training, and written guidance) were delivered sequentially. Outcomes measures were the MTB's ability to reach a decision, the quality of information presentation, and the quality of teamwork (as assessed by trained assessors using a previously validated observational assessment tool). The efficacy of the intervention was evaluated using multivariate analyses. RESULTS There were 1,421 patients studied between December 2009 and April 2, 2011. All outcomes improved considerably between baseline and intervention implementation: the MTB's ability to reach a decision rose from 82.2% to 92.7%, quality of information presentation rose from 29.6% to 38.3%, and quality of teamwork rose from 37.8% to 43.0%. The MTB's ability to reach a treatment decision was related to the quality of available information (r = 0.298; p < 0.05) and quality of teamwork within the MTB (r = 0.348; p < 0.05). The most common barriers to reaching clinical decisions were inadequate radiologic information (n = 77), inadequate pathologic information (n = 51), and inappropriate patient referrals (n = 21). CONCLUSIONS Multidisciplinary tumor board-delivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care.
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Affiliation(s)
- Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Ke KM, Blazeby JM, Strong S, Carroll FE, Ness AR, Hollingworth W. Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:7. [PMID: 23557141 PMCID: PMC3623820 DOI: 10.1186/1478-7547-11-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/12/2013] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care. Design Systematic review. Data sources EMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cohort, case–control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting. Data extraction Two independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs. Results Fifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings. Conclusions Current evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required.
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Affiliation(s)
- K Melissa Ke
- School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK.
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Kersten C, Cvancarova M, Mjåland S, Mjåland O. Does in-house availability of multidisciplinary teams increase survival in upper gastrointestinal-cancer? World J Gastrointest Oncol 2013; 5:60-67. [PMID: 23671732 PMCID: PMC3648664 DOI: 10.4251/wjgo.v5.i3.60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/24/2012] [Accepted: 01/21/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the effect of the establishment of in-house multidisciplinary team (MDT) availability (iMDTa) on survival in upper gastrointestinal cancer (UGI) patients.
METHODS: In 2001, a cancer centre with irradiation and chemotherapy facilities was established in the Norwegian county of West Agder with a change of iMDTa (WA/MDT-Change). “iMDTa”-status was defined according to the availability of the necessary specialists within one institution on one campus, serving the population of one county. We compared survival rates during 2000-2008 for UGI patients living in counties with (MDT-Yes), without (MDT-No), with a mix (MDT-Mix) and WA/MDT-Change. Survival was calculated with Kaplan-Meier method. Cox model was used to uncover differences between counties with different MDT status when adjusted for age, sex and stage.
RESULTS: We analyzed 395 patients from WA/MDT-Change and compared their survival to 12 135 UGI patients from four other Norwegian regions. Median overall survival for UGI patients in WA/MDT-Change increased from 129 to 300 d from 2000-2008, P = 0.001. The regions with the highest level of iMDTa achieved the largest decrease in risk of death for UGI cancers (compared to the county with MDT-Mix: MDT-Yes 11%, P < 0.05 and WA/MDT-Change 15%, P < 0.05). Analyzing the different tumour entities separately, patients living in the WA/MDT-Change county reached a statistically significant reduction in the risk of death [hazard ratios (HR)] compared to patients in the county with MDT-Mix for oesophageal and gastric, but not for pancreatic cancer. HR for the study period 2000-2004 are given first and then for the period 2005-2008: The HR for oesophageal cancers was reduced from [HR = 1.12; 95%CI: 0.75-1.68 to HR = 0.60, 95%CI: 0.38-0.95] and for gastric cancers from [HR = 0.87, 95%CI: 0.66-1.15 to HR = 0.63, 95%CI: 0.43-0.93], but not for pancreatic cancer [HR = 1.04-, 95%CI: 0.83-1.3 for 2000-2004 and HR = 1.01, 95%CI: 0.78-1.3 for 2005-2008]. UGI patients treated during the second study period in the county of WA/MDT-Change had a higher probability of receiving chemotherapy. In the first study period, only one out of 43 patients (2.4%, 95%CI: 0-6.9) received chemotherapy, compared to 18 of 42 patients diagnosed during 2005-2008 (42.9%, 95%CI: 28.0-57.8).
CONCLUSION: Introduction of iMDTa led to a two-fold increase of UGI patients, whereas no increase in survival was found in the MDT-No or MDT-Mix counties.
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Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: an interview study of the provider perspective. Int J Surg 2013; 11:389-94. [PMID: 23500030 DOI: 10.1016/j.ijsu.2013.02.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/06/2013] [Accepted: 02/28/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. METHODS Semi-structured interviews were carried out with expert MDT members of Urological and Gastro-Intestinal tumours of 3 London (UK) hospitals. The standardised interview protocol assessed MDT experts' views on decision-making, barriers to reaching a decision and implementing it into care, and interventions to improve this process. All interviews were audio-taped, transcribed verbatim and analysed using a standardised approach. Emergent themes were identified by 2 clinical coders and tabulated. RESULTS Twenty-two participants participated in the study and data collection achieved 'saturation' (i.e., similar themes raised by different participants). Barriers to clinical decision-making included: inadequate clinical information; lack of investigation results; non-attendance of key members; teleconferencing failures. Barriers to implementation of MDT recommendations included: non-consideration of patients' choices or co-morbidities; disease progression at the time of implementation. Proposed interventions included improving the information available for the discussion through a standardised proforma; improving video-conferencing; reducing the MDT caseload (e.g., via selective MDT review of certain patients); and including patients more in the decision process. CONCLUSIONS There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care.
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Meagher AP. Colorectal cancer: are multidisciplinary team meetings a waste of time? ANZ J Surg 2013; 83:101-3. [DOI: 10.1111/ans.12052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jalil R, Lamb B, Russ S, Sevdalis N, Green JS. The cancer multi-disciplinary team from the coordinators' perspective: results from a national survey in the UK. BMC Health Serv Res 2012; 12:457. [PMID: 23237502 PMCID: PMC3539898 DOI: 10.1186/1472-6963-12-457] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022] Open
Abstract
Background The MDT-Coordinators’ role is relatively new, and as such it is evolving. What is apparent is that the coordinator’s work is pivotal to the effectiveness and efficiency of an MDT. This study aimed to assess the views and needs of MDT-coordinators. Methods Views of MDT-coordinators were evaluated through an online survey that covered their current practice and role, MDT chairing, opinions on how to improve MDT meetings, and coordinators’ educational/training needs. Results 265 coordinators responded to the survey. More than one third of the respondents felt that the job plan does not reflect their actual duties. It was reported that medical members of the MDT always contribute to case discussions. 66.9% of the respondents reported that the MDTs are chaired by Surgeons. The majority reported having training on data management and IT skills but more than 50% reported that they felt further training is needed in areas of Oncology, Anatomy and physiology, audit and research, peer-review, and leadership skills. Conclusions MDT-Coordinators’ role is central to the care of cancer patients. The study reveals areas of training requirements that remain unmet. Improving the resources and training available to MDT-coordinators can give them an opportunity to develop the required additional skills and contribute to improved MDT performance and ultimately cancer care. Finally, this study looks forward to the impact of the recent launch of a new e-learning training programme for MDT coordinators and discusses implications for future research.
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Lamb BW, Taylor C, Lamb JN, Strickland SL, Vincent C, Green JSA, Sevdalis N. Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study. Ann Surg Oncol 2012; 20:1408-16. [DOI: 10.1245/s10434-012-2676-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Indexed: 12/24/2022]
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Lamb BW, Sevdalis N, Benn J, Vincent C, Green JSA. Multidisciplinary Cancer Team Meeting Structure and Treatment Decisions: A Prospective Correlational Study. Ann Surg Oncol 2012; 20:715-22. [DOI: 10.1245/s10434-012-2691-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Indexed: 12/24/2022]
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Feroci F, Lenzi E, Baraghini M, Cantafio S, Scatizzi M. General surgeons' views on Oncologic Multidisciplinary Group meetings as part of colorectal cancer care. Updates Surg 2012; 64:273-8. [PMID: 22987014 DOI: 10.1007/s13304-012-0181-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 09/06/2012] [Indexed: 12/01/2022]
Abstract
This study aimed to assess the current effectiveness of Oncologic Multidisciplinary Groups (OMGs) meetings across central Tuscany through surgeons' reports and their individual perceived benefits on colorectal cancer management. One hundred and sixty-seven general surgeons received a questionnaire with 21 questions covering organizational characteristics of OMGs and the individual perceived benefits of OMGs. The responses were analyzed by hospital setting (teaching vs. community hospital). The reply rate was 62.8 %, and 82 respondent surgeons (49.1 %) were involved in the treatment of colorectal cancer patients. At community hospitals, there was a more frequent participation of medical oncologists, radiation oncologists and pathologists; a less selection of discussed cases was performed; and almost all decisions were inserted into official patient charts (p < 0.05). Community hospital surgeons perceived more of a benefit than academic surgeons: OMGs ensure that all treatment options are considered and improve timeliness of care, patient outcomes, patient satisfaction and communication with patients (p < 0.05). The surveyed surgeons reported that OMGs offer a modest degree of protection from malpractice but improve communications between colleagues and are an opportunity for personal professional development. Professionals regularly participating in well-conducted and well-organized OMGs for colorectal cancer felt that the multidisciplinary strategy may be advantageous to both patients and caregivers.
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Affiliation(s)
- Francesco Feroci
- General Surgery Unit, Misericordia and Dolce Hospital, Ospedale Misericordia e Dolce Piazza dell'Ospedale 5, 59100, Prato, PO, Italy.
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Taban F, Rapiti E, Fioretta G, Wespi Y, Weintraub D, Hugli A, Schubert H, Vlastos G, Castiglione M, Bouchardy C. Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias. Ann Oncol 2012; 24:116-25. [PMID: 22945380 DOI: 10.1093/annonc/mds285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective. PATIENTS AND METHODS We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score. RESULTS Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4). CONCLUSIONS This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.
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Affiliation(s)
- F Taban
- SONGe (Séno ONcologie Genevoise), Geneva Private Practitioners Breast Cancer Network, Geneva, Switzerland
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Ellis P. The importance of multidisciplinary team management of patients with non-small-cell lung cancer. Curr Oncol 2012; 19:S7-S15. [PMID: 22787414 PMCID: PMC3377758 DOI: 10.3747/co.19.1069] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Historically, a simple approach to the treatment of non-small-cell lung cancer (nsclc) was applicable to nearly all patients. Recently, a more complex treatment algorithm has emerged, driven by both pathologic and molecular phenotype. This increasing complexity underscores the importance of a multidisciplinary team approach to the diagnosis, treatment, and supportive care of patients with nsclc. A team approach to management is important at all points: from diagnosis, through treatment, to end-of-life care. It also needs to be patient-centred and must involve the patient in decision-making concerning treatment. Multidisciplinary case conferencing is becoming an integral part of care. Early integration of palliative care into the team approach appears to contribute significantly to quality of life and potentially extends overall survival for these patients. Supportive approaches, including psychosocial and nutrition support, should be routinely incorporated into the team approach. Challenges to the implementation of multidisciplinary care require institutional commitment and support.
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Affiliation(s)
- P.M. Ellis
- Correspondence to: Peter M. Ellis, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2. E-mail:
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Gomella LG. Prostate cancer: the benefits of multidisciplinary prostate cancer care. Nat Rev Urol 2012; 9:360-2. [PMID: 22565373 DOI: 10.1038/nrurol.2012.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JSA. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol 2012; 23:1293-1300. [PMID: 22015450 DOI: 10.1093/annonc/mdr453] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Using data from a national survey, this study aimed to address whether the current model for multidisciplinary team (MDT) working is appropriate for all tumour types. PATIENTS AND METHODS Responses to the 2009 National Cancer Action Team national survey were analysed by tumour type. Differences indicate lack of consensus between MDT members in different tumour types. RESULTS One thousand one hundred and forty-one respondents from breast, gynaecological, colorectal, upper gastrointestinal, urological, head and neck, haematological and lung MDTs were included. One hundred and sixteen of 136 statements demonstrated consensus between respondents in different tumour types. There were no differences regarding the infrastructure for meetings and team governance. Significant consensus was seen for team characteristics, and respondents disagreed regarding certain aspects of meeting organisations and logistics, and patient-centred decision making. Haematology MDT members were outliers in relation to the clinical decision-making process, and lung MDT members disagreed with other tumour types regarding treating patients with advanced disease. CONCLUSIONS This analysis reveals strong consensus between MDT members from different tumour types, while also identifying areas that require a more tailored approach, such as the clinical decision-making process, and preparation for and the organisation of MDT meetings. Policymakers should remain sensitive to the needs of health care teams working in individual tumour types.
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Affiliation(s)
- B W Lamb
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London; Department of Urology, Whipps Cross University Hospital, London.
| | - N Sevdalis
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London
| | - C Taylor
- Florence Nightingale School of Nursing and Midwifery, Kings College London, London, UK
| | - C Vincent
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London
| | - J S A Green
- Department of Urology, Whipps Cross University Hospital, London
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Kesson EM, Allardice GM, George WD, Burns HJG, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344:e2718. [PMID: 22539013 PMCID: PMC3339875 DOI: 10.1136/bmj.e2718] [Citation(s) in RCA: 388] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the effect of multidisciplinary care on survival in women treated for breast cancer. DESIGN Retrospective, comparative, non-randomised, interventional cohort study. SETTING NHS hospitals, health boards in the west of Scotland, UK. PARTICIPANTS 14,358 patients diagnosed with symptomatic invasive breast cancer between 1990 and 2000, residing in health board areas in the west of Scotland. 13,722 (95.6%) patients were eligible (excluding 16 diagnoses of inflammatory cancers and 620 diagnoses of breast cancer at death). INTERVENTION In 1995, multidisciplinary team working was introduced in hospitals throughout one health board area (Greater Glasgow; intervention area), but not in other health board areas in the west of Scotland (non-intervention area). MAIN OUTCOME MEASURES Breast cancer specific mortality and all cause mortality. RESULTS Before the introduction of multidisciplinary care (analysed time period January 1990 to September 1995), breast cancer mortality was 11% higher in the intervention area than in the non-intervention area (hazard ratio adjusted for year of incidence, age at diagnosis, and deprivation, 1.11; 95% confidence interval 1.00 to 1.20). After multidisciplinary care was introduced (time period October 1995 to December 2000), breast cancer mortality was 18% lower in the intervention area than in the non-intervention area (0.82, 0.74 to 0.91). All cause mortality did not differ significantly between populations in the earlier period, but was 11% lower in the intervention area than in the non-interventional area in the later period (0.89, 0.82 to 0.97). Interrupted time series analyses showed a significant improvement in breast cancer survival in the intervention area in 1996, compared with the expected survival in the same year had the pre-intervention trend continued (P=0.004). This improvement was maintained after the intervention was introduced. CONCLUSION Introduction of multidisciplinary care was associated with improved survival and reduced variation in survival among hospitals. Further analysis of clinical audit data for multidisciplinary care could identify which aspects of care are most associated with survival benefits.
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Affiliation(s)
- Eileen M Kesson
- NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, Glasgow, UK.
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Lamb BW, Sevdalis N, Vincent C, Green JSA. Development and evaluation of a checklist to support decision making in cancer multidisciplinary team meetings: MDT-QuIC. Ann Surg Oncol 2011; 19:1759-65. [PMID: 22207050 DOI: 10.1245/s10434-011-2187-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The quality of decision-making in cancer multidisciplinary team (MDT) meetings is variable, which can result in suboptimal clinical decision making. We developed MDT-QuIC, an evidence-based tool to support clinical decision making by MDTs, which was evaluated by key users. METHODS Following a literature review, factors important for high-quality clinical decision making were listed and then converted into a preliminary checklist by clinical and safety experts. Attitudes of MDT members toward the tool were evaluated via an online survey, before adjustments were made giving rise to a final version: MDT-QuIC. RESULTS The checklist was evaluated by 175 MDT members (surgeons = 38, oncologists = 40, specialist nurses = 62, and MDT coordinators = 35). Attitudes toward the checklist were generally positive (P < 0.001, 1-sample t test), although nurses were more positive than other groups regarding whether the checklist would improve their contribution in MDT meetings (P < 0.001, Mann-Whitney U test). Participants thought that the checklist could be used to prepare cases for MDT meetings, to structure and guide case discussions, or as a record of MDT discussion. Regarding who could use the checklist, 70% thought it should be used by the MDT chair, 54% by the MDT coordinator, and 38% thought all MDT members should use it. CONCLUSION We have developed and validated an evidence-based tool to support the quality of MDT decision making. MDT members were positive about the checklist and felt it may help to structure discussion, improve inclusivity, and patient centeredness. Further research is needed to assess its effect on patient care and outcomes.
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Affiliation(s)
- B W Lamb
- Department of Surgery and Cancer, Imperial College London, London, UK.
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The Prostate Cancer Unit: A Multidisciplinary Approach for Which the Time Has Arrived. Eur Urol 2011; 60:1197-9. [DOI: 10.1016/j.eururo.2011.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/09/2011] [Indexed: 11/17/2022]
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Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the urology clinical nurse specialist in the multidisciplinary team meeting. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2011. [DOI: 10.1111/j.1749-771x.2011.01119.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and Team Decision-making at Multidisciplinary Cancer Conferences: Barriers, Facilitators, and Opportunities for Improvement. World J Surg 2011; 35:1970-6. [DOI: 10.1007/s00268-011-1152-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol 2011; 18:3535-43. [PMID: 21594706 DOI: 10.1245/s10434-011-1773-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members' contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance. MATERIALS AND METHODS Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients' views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere-Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman's correlations. RESULTS Quality of information presentation: Case histories and radiology information rated highest; patients' views and comorbidities/psychosocial issues rated lowest (observed: Z = 14.80, P ≤ 0.001; self-report: Z = 3.70, P < 0.001). Contribution to decision-making: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed: Z = 20.00, P ≤ 0.001; self-report: Z = 8.10, P < 0.001). Correlations between observational and self-report assessments: Median Spearman's rho = 0.74 (range = 0.66-0.91; P < 0.05). CONCLUSIONS The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.
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Affiliation(s)
- B W Lamb
- Department of Surgery and Cancer, Imperial College London, 5th Floor Medical School Building, St. Mary's Hospital, London, UK.
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Lamb BW, Brown KF, Nagpal K, Vincent C, Green JSA, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol 2011; 18:2116-25. [PMID: 21442345 DOI: 10.1245/s10434-011-1675-6] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Factors that affect the quality of clinical decisions of multidisciplinary cancer teams (MDTs) are not well understood. We reviewed and synthesised the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making. METHODS Electronic databases were searched in May 2009. Eligible studies reported original data, quantitative or qualitative. Data were extracted and tabulated by two blinded reviewers, and study quality formally evaluated. RESULTS Thirty-seven studies were included. Study quality was low to medium. Studies assessed quality of care decisions via the effect of MDTs on care management. MDTs changed cancer management by individual physicians in 2-52% of cases. Failure to reach a decision at MDT discussion was found in 27-52% of cases. Decisions could not be implemented in 1-16% of cases. Team decisions are made by physicians, using clinical information. Nursing personnel do not have an active role, and patient preferences are not discussed. Time pressure, excessive caseload, low attendance, poor teamworking and lack of leadership lead to lack of information and deterioration of decision-making. Telemedicine is increasingly used in developed countries, with no detriment to quality of MDT decisions. CONCLUSIONS Team/social factors affect management decisions by cancer MDTs. Inclusion of time to prepare for MDTs into team-members' job plans, making team and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings. These improvements ought to be considered at national policy level, with the ultimate aim of improving cancer care.
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Affiliation(s)
- Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, London, UK.
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