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Lamprell K, Chittajallu R, Arnolda G, Easpaig BNG, Delaney GP, Liauw W, Olver I, Braithwaite J. Multidisciplinary team meeting Chairs' attitudes and perceived facilitators, barriers and ideal improvements to meeting functionality: A qualitative study. Asia Pac J Clin Oncol 2024; 20:537-545. [PMID: 38757440 DOI: 10.1111/ajco.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
AIM Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre-meeting patient list triage to post-meeting dissemination of recommendations. METHODS Semi-structured interviews were conducted in person with Chairs within two urban geographical regions in New South Wales, Australia as part of a larger project. Though the population of oncology MDT Chairs in Australia is small, the richness and depth of data from nine Chairs were considered to be valuable knowledge in support of extant literature on meeting functionality. An integrated deductive-inductive approach was applied to data analysis. RESULTS Perceived facilitators, barriers, and ideals relating to pre-meeting, in-meeting, and post-meeting functionality were identified across five pre-determined analytic categories: the team; meeting infrastructure; meeting organization and logistics; patient-centered clinical decision-making, and; team governance. Key barriers included inadequate information technology, limited support staff, and lack of dedicated time for Chair duties. Corresponding facilitators included robust Information Technology infrastructure and support, provision of clinically knowledgeable MDT meeting coordinators, and formal employment recognition of Chairs' responsibilities and skill sets. CONCLUSION Chairs across various tumor streams develop workarounds to overcome barriers and ensure quality meeting outcomes. With more robust support they could enhance value by sharing evidence, conducting audits, and engaging in research. The findings highlight the need for healthcare systems to support tumor stream clinical networks by allocating greater resources to prioritize multidisciplinary meetings and cancer care decision-making.
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Affiliation(s)
- Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Renuka Chittajallu
- Medical Oncology, Riverina Cancer Care Centre, Wagga Wagga, Australia
- Medical Oncology, GenesisCare, Kingswood, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- School of Nursing, Charles Darwin University, Darwin, Australia
| | - Geoff P Delaney
- South-Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Radiation Oncology, Liverpool Hospital, Liverpool, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Stirling RG, Harrison A, Huang J, Lee V, Taverner J, Barnes H. Multidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230157. [PMID: 38719736 PMCID: PMC11078104 DOI: 10.1183/16000617.0157-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis, staging and treatment may be enhanced by multidisciplinary participation and presentation in multidisciplinary meetings (MDM). We performed a systematic review and meta-analysis to explore literature evidence of clinical impacts of MDM exposure. METHODS A study protocol was registered (PROSPERO identifier CRD42021258069). Randomised controlled trials and observational cohort studies including adults with nonsmall cell lung cancer and who underwent MDM review, compared to no MDM, were included. MEDLINE, CENTRAL, Embase and ClinicalTrials.gov were searched on 31 May 2021. Studies were screened and extracted by two reviewers. Outcomes included time to diagnosis and treatment, histological confirmation, receipt of treatments, clinical trial participation, survival and quality of life. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool. RESULTS 2947 citations were identified, and 20 studies were included. MDM presentation significantly increased histological confirmation of diagnosis (OR 3.01, 95% CI 2.30-3.95; p<0.00001) and availability of clinical staging (OR 2.55, 95% CI 1.43-4.56; p=0.002). MDM presentation significantly increased likelihood of receipt of surgery (OR 2.01, 95% CI 1.29-3.12; p=0.002) and reduced the likelihood of receiving no active treatment (OR 0.32, 95% CI 0.21-0.50; p=0.01). MDM presentation was protective of both 1-year survival (OR 3.23, 95% CI 2.85-3.68; p<0.00001) and overall survival (hazard ratio 0.63, 95% CI 0.55-0.72; p<0.00001). DISCUSSION MDM presentation was associated with increased likelihood of histological confirmation of diagnosis, documentation of clinical staging and receipt of surgery. Overall and 1-year survival was better in those presented to an MDM, although there was some clinical heterogeneity in participants and interventions delivered. Further research is required to determine the optimal method of MDM presentation, and address barriers to presentation.
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Affiliation(s)
- Rob G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amelia Harrison
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Joanna Huang
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Vera Lee
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Taverner
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Liu M, Yu Q, Liu Y. Developing quality indicators for cancer hospitals in China: a national modified Delphi process. BMJ Open 2024; 14:e082930. [PMID: 38594187 PMCID: PMC11015267 DOI: 10.1136/bmjopen-2023-082930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE Although demand and supply of cancer care have been rapidly increasing in recent decades, there is a lack of systemic quality measurement for cancer hospitals in China. This study aimed to develop a set of core indicators for measuring quality of care for cancer hospitals in China. DESIGN The development of quality indicators was based on a literature review and a two-round modified Delphi survey. The theoretical framework and initial indicators were identified through the comprehensive literature review, and the selection of quality indicators relied on experts' consensus on the importance and feasibility of indicators by the modified Delphi process. In addition, indicator weight was identified using the analytical hierarchical process method and percentage weight method. SETTING AND PARTICIPANTS A panel of leading experts including oncologists, cancer care nurses, quality management experts from various regions of China were invited to participate in the two-round modified Delphi process from October to December 2020. A total of 25 experts completed the two-round modified Delphi process. RESULTS The experts reached consensus on a set of 47 indicators, comprising 17 structure indicators, 19 process indicators and 11 outcome indicators. Experts gave much higher weight to outcome indicators (accounting for 53.96% relative weight) than to structure (16.34%) and process (29.70%) indicators. In addition, experts also showed concerns and gave suggestions on data availability of specific outcome indicators. CONCLUSIONS Drawing on the comprehensive literature review and the modified Delphi process, this study developed a core set of quality indicators that can be used to evaluate quality performance of cancer hospitals. This is helpful in supporting quality cancer care in China and will provide new insights into the systemic measurement of cancer care internationally.
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Affiliation(s)
- Meicen Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyuan Yu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Almashmoum M, Cunningham J, Alkhaldi O, Anisworth J. Factors That Affect Knowledge-Sharing Behaviors in Medical Imaging Departments in Cancer Centers: Systematic Review. JMIR Hum Factors 2023; 10:e44327. [PMID: 37436810 PMCID: PMC10372764 DOI: 10.2196/44327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Knowledge management plays a significant role in health care institutions. It consists of 4 processes: knowledge creation, knowledge capture, knowledge sharing, and knowledge application. The success of health care institutions relies on effective knowledge sharing among health care professionals, so the facilitators and barriers to knowledge sharing must be identified and understood. Medical imaging departments play a key role in cancer centers. Therefore, an understanding of the factors that affect knowledge sharing in medical imaging departments should be sought to increase patient outcomes and reduce medical errors. OBJECTIVE The purpose of this systematic review was to identify the facilitators and barriers that affect knowledge-sharing behaviors in medical imaging departments and identify the differences between medical imaging departments in general hospitals and cancer centers. METHODS We performed a systematic search in PubMed Central, EBSCOhost (CINAHL), Ovid MEDLINE, Ovid Embase, Elsevier (Scopus), ProQuest, and Clarivate (Web of Science) in December 2021. Relevant articles were identified by examining the titles and abstracts. In total, 2 reviewers independently screened the full texts of relevant papers according to the inclusion and exclusion criteria. We included qualitative, quantitative, and mixed methods studies that investigated the facilitators and barriers that affect knowledge sharing. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles and narrative synthesis to report the results. RESULTS A total of 49 articles were selected for the full in-depth analysis, and 38 (78%) studies were included in the final review, with 1 article added from other selected databases. There were 31 facilitators and 10 barriers identified that affected knowledge-sharing practices in medical imaging departments. These facilitators were divided according to their characteristics into 3 categories: individual, departmental, and technological facilitators. The barriers that hindered knowledge sharing were divided into 4 categories: financial, administrative, technological, and geographical barriers. CONCLUSIONS This review highlighted the factors that influenced knowledge-sharing practices in medical imaging departments in cancer centers and general hospitals. In terms of the facilitators and barriers to knowledge sharing, this study shows that these are the same in medical imaging departments, whether in general hospitals or cancer centers. Our findings can be used as guidelines for medical imaging departments to support knowledge-sharing frameworks and enhance knowledge sharing by understanding the facilitators and barriers.
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Affiliation(s)
- Maryam Almashmoum
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Nuclear Medicine Department, Faisal Sultan Bin Eissa, Kuwait Cancer Control Center, Kuwait City, Kuwait
| | - James Cunningham
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Ohoud Alkhaldi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - John Anisworth
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Li C, Wang Z, Yang W, Ai G, Cheng Z. Application of Minimally Invasive Surgery-Multidisciplinary Team in Advanced and Recurrent Gynecological Cancers: 10-Year Exploration and Practice. Gynecol Minim Invasive Ther 2023; 12:141-147. [PMID: 37807982 PMCID: PMC10553593 DOI: 10.4103/gmit.gmit_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives The treatment of advanced and recurrent gynecological cancers (ARGCs) remains more difficult evens. This assay aims to introduce the application of minimally invasive surgery-multidisciplinary team (MIS-MDT) as well as a comprehensive evaluation and treatment program of ARGC. Materials and Methods The diagnosis and treatment model of MDT collaboration has become a new model of clinical cancer treatment. In my country, it is in the start-up and trial stage. Our team began to explore surgical treatment of recurrent gynecological cancers in 2011 and has been committed to MDT treatment of ARGC for more than 3 years. Results So far, 61 patients have completed MDT treatment (28 of them were advanced gynecological cancer patients, 33 of them were recurrent gynecological cancer patients). Among them, MDT involved 43 times in gastrointestinal surgery, 21 times in urology, 5 times in the department of intractable abdominal diseases, and 5 times in other departments. After surgery, 58 patients (95%) restarted adjuvant therapy such as radiotherapy and chemotherapy. In addition, 32 patients (52.5%) underwent genetic and molecular testing, of which 14 patients (23%) accepted targeted and immunotherapy based on the testing results. After MIS-MDT treatment, the median progression-free survival of these patients was >30 months, respectively. Conclusion These patients have achieved good results after surgery of MDT. With continuous accumulation and summarization, we have systematically reviewed the diagnosis and treatment model of ARGC and guided clinical work as the model of Tongji Tenth Hospital (comprehensive evaluation and treatment).
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Affiliation(s)
- Caixia Li
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongjie Wang
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weihong Yang
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
| | - Guihai Ai
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
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Walraven JEW, Verhoeven RHA, van der Hoeven JJM, van der Meulen R, Lemmens VEPP, Hesselink G, Desar IME. Pros and cons of streamlining and use of computerised clinical decision support systems to future-proof oncological multidisciplinary team meetings. Front Oncol 2023; 13:1178165. [PMID: 37274246 PMCID: PMC10233094 DOI: 10.3389/fonc.2023.1178165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Nowadays nearly every patient with cancer is discussed in a multidisciplinary team meeting (MDTM) to determine an optimal treatment plan. The growth in the number of patients to be discussed is unsustainable. Streamlining and use of computerised clinical decision support systems (CCDSSs) are two major ways to restructure MDTMs. Streamlining is the process of selecting the patients who need to be discussed and in which type of MDTM. Using CCDSSs, patient data is automatically loaded into the minutes and a guideline-based treatment proposal is generated. We aimed to identify the pros and cons of streamlining and CCDSSs. Methods Semi-structured interviews were conducted with Dutch MDTM participants. With purposive sampling we maximised variation in participants' characteristics. Interview data were thematically analysed. Results Thirty-five interviews were analysed. All interviewees agreed on the need to change the current MDTM workflow. Streamlining suggestions were thematised based on standard and complex cases and the location of the MDTM (i.e. local, regional or nationwide). Interviewees suggested easing the pressure on MDTMs by discussing standard cases briefly, not at all, or outside the MDTM with only two to three specialists. Complex cases should be discussed in tumour-type-specific regional MDTMs and highly complex cases by regional/nationwide expert teams. Categorizing patients as standard or complex was found to be the greatest challenge of streamlining. CCDSSs were recognised as promising, although none of the interviewees had made use of them. The assumed advantage was their capacity to generate protocolised treatment proposals based on automatically uploaded patient data, to unify treatment proposals and to facilitate research. However, they were thought to limit the freedom to deviate from the treatment advice. Conclusion To make oncological MDTMs sustainable, methods of streamlining should be developed and introduced. Physicians still have doubts about the value of CCDSSs.
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Affiliation(s)
- Janneke E. W. Walraven
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Rob H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
- Department of Medical Oncology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, Netherlands
| | | | - Renske van der Meulen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Gijs Hesselink
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ingrid M. E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
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Creemers SG, Van Santvoort B, van den Berkmortel FWPJ, Kiemeney LA, van Oort IM, Aben KKH, Hamberg P. Role of multidisciplinary team meetings in implementation of chemohormonal therapy in metastatic prostate cancer in daily practice. Prostate Cancer Prostatic Dis 2023; 26:133-141. [PMID: 35798856 DOI: 10.1038/s41391-022-00556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The recommended treatment for a subset of patients with metastatic prostate cancer (mPC) changed from androgen deprivation therapy (ADT) to combinations with chemotherapy such as docetaxel. Implementation of new evidence from trials is however complex and challenging. We investigated the effect of multidisciplinary team meetings (MDTs) on adopting the newest emerging combination therapy in patients with mPC and assessed the overall survival of chemohormonal therapy in a real-world setting. METHODS All mPC patients diagnosed between October 2015 and April 2016 in the Netherlands were identified from the population-based Netherlands Cancer Registry (n = 962). Logistic regression analyses were performed to examine the role of patient- and tumor characteristics, with special emphasis on MDTs, on receiving chemohormonal therapy versus ADT monotherapy. Kaplan-Meier survival curves were used to assess overall survival (OS). RESULTS As many patients received ADT monotherapy as chemohormonal therapy (both n = 452). Being discussed in a MDT as patient, younger age, less comorbidities, a better performance status and high-volume disease were significantly associated with receiving chemohormonal therapy compared to ADT monotherapy. After adjustment for these factors, the presence of a MDT was independently associated with the administration of chemohormonal therapy (OR 2.77, 95% CI 1.68-4.59). The 2-year OS was 82.1% (95% CI: 78.5-85.6%) for patients receiving chemohormonal therapy and 59.9% (95% CI: 55.4-64.4%) for patients receiving ADT monotherapy. CONCLUSION Being discussed in a MDT is independently associated with the administration of chemohormonal therapy in this group of patients with mPC. This supports the hypothesis that implementation of innovative treatment options is facilitated by an organizational structure with MDTs.
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Affiliation(s)
- S G Creemers
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands.
| | - B Van Santvoort
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | | | - L A Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K K H Aben
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Hamberg
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
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Rosell L, Melander W, Lindahl B, Nilbert M, Malmström M. Registered nurses' views on consideration of patient perspectives during multidisciplinary team meetings in cancer care. BMC Nurs 2022; 21:350. [PMID: 36494850 PMCID: PMC9732978 DOI: 10.1186/s12912-022-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Wenche Melander
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Berit Lindahl
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.4514.40000 0001 0930 2361Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Mef Nilbert
- grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Marlene Malmström
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
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Schellenberger B, Heuser C, Diekmann A, Ernstmann N, Schippers A, Geiser F, Schmidt‐Wolf IGH, Scholl I, Ansmann L. How shared is decision‐making in multidisciplinary tumour conferences with patient participation? An observational study. Health Expect 2022; 25:3297-3306. [DOI: 10.1111/hex.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Anna Schippers
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Franziska Geiser
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine University Hospital Bonn Bonn Germany
| | - Ingo G. H. Schmidt‐Wolf
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department of Integrated Oncology University Hospital Bonn Bonn Germany
| | - Isabelle Scholl
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Division for Organizational Health Services Research Carl von Ossietzky University Oldenburg Oldenburg Germany
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Smith J, Braithwaite J, O'Brien TA, Smith S, Tyrrell VJ, Mould EVA, Long JC, Rapport F. The Voices of Stakeholders Involved in Precision Medicine: The Co-Design and Evaluation of Qualitative Indicators of Intervention Acceptability, Fidelity and Context in PRecISion Medicine for Children With Cancer in Australia. QUALITATIVE HEALTH RESEARCH 2022; 32:1865-1880. [PMID: 36066496 DOI: 10.1177/10497323221120501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We report a novel approach of amalgamating implementation outcomes of acceptability and fidelity alongside context as a new way of qualitatively evaluating implementation outcomes and context of a precision medicine intervention. A rapid qualitative online proforma was co-designed with stakeholders and sent to a purposive sample of healthcare professionals involved in an early-phase clinical trial intervention. Data were analysed using Framework Analysis. A total of 24 out of 68 proformas were returned. Although some participants raised concerns about drug medication access issues, the main intervention was well accepted and understood across professional groups. Comprehension was enhanced through exposure to specialist multidisciplinary meeting arrangements. In conclusion, a rapid data collection tool and framework are now available to assess readily measurable, qualitative indicators of acceptability, fidelity of receipt and contextual fit within the dynamic precision medicine context.
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Affiliation(s)
- James Smith
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Tracey A O'Brien
- Faculty of Medicine, School of Women's and Children's Health, 7800University of New South Wales, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Stephanie Smith
- School of Population Health, 1649Curtin University, Perth, WA, Australia
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | - Vanessa J Tyrrell
- Children's Cancer Institute, 188680Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Emily V A Mould
- Children's Cancer Institute, 188680Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Schellenberger B, Heuser C, Diekmann A, Ansmann L, Krüger E, Schreiber L, Schnettler B, Geiser F, Schmidt-Wolf IGH, Ernstmann N. Questions and emotional expressions from patients and companions while participating in multidisciplinary tumor conferences in breast and gynecological cancer centers. PATIENT EDUCATION AND COUNSELING 2022; 105:2058-2066. [PMID: 34953619 DOI: 10.1016/j.pec.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate (a) how many questions and negative emotions (cues/concerns) breast and/or gynecologic cancer patients and companions express during their case discussion in multidisciplinary tumor conferences (MTCs), (b) with which topics the emotions are linked, and (c) which patient- and context-related characteristics determine patients' communicative behavior. METHODS This observational study included audio/video recordings of MTCs with patient participation in three breast and gynecological cancer centers. Using the Verona Coding Definitions of Emotional Sequences, patients' and companions' questions and negative emotions expressed were analyzed. Multiple regression analyses were used to determine associations between communicative behavior and patient- and context-related characteristics. RESULTS We identified 607 questions and 230 cues/concerns expressed by patients/companions in 82 case discussions in MTCs. The number of questions was significantly associated with the hospital. In case discussions with patients who had need for psychological support and who were accompanied, more questions were asked by patients/companions. CONCLUSION The results show that active patient participation does not depend only on patient characteristics, but also on the hospital setting. PRACTICE IMPLICATIONS If cancer centers want to enable patient participation in MTCs, they must define the role of the patient before. Subsequently, conditions must be created to enable this role expectation.
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Affiliation(s)
- Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany.
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Emily Krüger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Leonie Schreiber
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | | | - Franziska Geiser
- Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Germany
| | - Ingo G H Schmidt-Wolf
- Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Department of Integrated Oncology, University Hospital, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
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12
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Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res 2022; 22:829. [PMID: 35761282 PMCID: PMC9238082 DOI: 10.1186/s12913-022-08112-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
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.
Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08112-0.
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Casadio M, Cardinale V, Klümpen HJ, Morement H, Lacasta A, Koerkamp B, Banales J, Alvaro D, Valle J, Lamarca A. Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). ESMO Open 2022; 7:100377. [PMID: 35093741 PMCID: PMC8804175 DOI: 10.1016/j.esmoop.2021.100377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cholangiocarcinomas (CCAs) are a rare group of malignancies characterized by dismal prognosis. There are currently no standardized guidelines for multidisciplinary teams (MDTs) in CCAs. MATERIAL AND METHODS An online survey was built with the aim of defining the current practice of MDTs in CCAs and identifying possible areas of improvement, providing minimum standards of practice for an ideal CCA MDT. Analysis of the replies regarding current and ideal MDT practice was carried out by calculating weighted average (WA) of likelihood of every item. The survey was shared with members of the European Network for the Study of Cholangiocarcinoma and other medical centers with expertise in biliary tract cancer part of the EURO-CHOLANGIO-NET (European Cholangiocarcinoma Network: https://eurocholangionet.eu/) COST Action CA18122 initiative. RESULTS The role of the MDT coordinator was a recognized priority in an ideal well-functioning MDT (WA 3.31/4), together with providing minimum clinical information before the meeting to secure adequate case preparation (WA 3.54/4). Optimal frequency of MDT meetings was weekly according to 76.92% of the participants; 73.06% believed that ideally all newly diagnosed patients and each new treatment should be discussed, although that happened only in less than half of the MDTs (46.15%) in current practice. Most participants stated that they always (46.15%) or often (50.00%) used guidelines, mainly international (61.00%) (European and American), followed by national/local (39.00%). We defined the ideal setup of a CCA MDT, identifying specialists whose presence is mandatory with WA >3.0 (oncologist, clinician responsible for patient's care, surgeon, diagnostic and interventional radiologist, hepatologist, pathologist, endoscopist and gastroenterologist) and those whose presence would be recommended with a WA <3.0 (palliative care, nurse, dietitian, basic researcher, psychologist and social worker). CONCLUSIONS Our identified minimum requirements should be taken into account at the time of CCA MDT setup and quality assessment.
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Affiliation(s)
- M. Casadio
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Department of Gastroenterology, Sapienza University of Rome, Rome, Italy
| | - V. Cardinale
- Medical-Surgical and Biotechnologies Sciences, Polo Pontino, Sapienza University of Rome, Latina, Italy
| | - H.-J. Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - H. Morement
- AMMF—The Cholangiocarcinoma Charity, Stansted, UK
| | - A. Lacasta
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastian, Spain
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | - B.G. Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - J. Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | - D. Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Department of Gastroenterology, Sapienza University of Rome, Rome, Italy
| | - J.W. Valle
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation, Manchester, UK
| | - A. Lamarca
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation, Manchester, UK
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Fradgley EA, Booth K, Paul C, Zdenkowski N, Rankin NM. Facilitating High Quality Cancer Care: A Qualitative Study of Australian Chairpersons' Perspectives on Multidisciplinary Team Meetings. J Multidiscip Healthc 2021; 14:3429-3439. [PMID: 34938082 PMCID: PMC8687680 DOI: 10.2147/jmdh.s332972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Aim Multidisciplinary team meetings (MDMs) are a critical element of quality care for people diagnosed with cancer. The MDM Chairperson plays a significant role in facilitating these meetings, which are often time-poor environments for clinical decision making. This study examines the perceptions of MDM Chairpersons including their role and the factors that determine the quality of a Chair, as well as the Chairperson's perception of the value of personally attending meetings. Methods This qualitative study used telephone interviews to explore the experiences of MDM Chairpersons from metropolitan and regional New South Wales, Australia. Using a state-wide register, 43 clinicians who chaired lung, genitourinary, gastrointestinal, and breast cancer meetings were approached to participate. Thematic data analysis was used to develop and organise themes. Results Themes from the 16 interviews identified the perceived need for an expert and efficient MDM Chairperson with emphasis on personal rather than technical skills. The remaining themes related to the benefits of meetings to ensure quality and consistency of care; improve inter-professional relationships; and provide communication with and reassurance for patients. Conclusion The role of the MDM Chairperson requires expert management and leadership skills to ensure meetings support quality patient-centred care. MDMs are perceived to provide multiple benefits to both clinicians and patients. Efforts to train Chairs and to maximise clinician and patient benefits may be warranted given the costly and time-consuming nature of MDMs.
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Affiliation(s)
- Elizabeth A Fradgley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Booth
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
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15
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Askelin B, Hind A, Paterson C. Exploring the impact of uro-oncology multidisciplinary team meetings on patient outcomes: A systematic review. Eur J Oncol Nurs 2021; 54:102032. [PMID: 34597962 DOI: 10.1016/j.ejon.2021.102032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/04/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Multidisciplinary team (MDT) meetings are mainstay clinical management globally. Clinical guidelines state that patients should be considered for MDT review, but evidence has identified that within the specialty of uro-oncology not all patients are reviewed by an MDT. This systematic review aimed to understand the impact of uro-oncology MDT meetings on patient outcomes, to explore how patient engagement is incorporated in the process, and to identify the barriers and facilitators within an MDT. METHODS A systematic review was reported according to PRISMA guidelines. Electronic databases (MEDLINE, CINAHL and PsychINFO) were searched in EBSCOhost from January 2010 to March 2021, using a range of key search words. Studies were assessed for inclusion according to a pre-defined eligibility criteria. Data extraction and quality assessment was undertaken. The findings were tabulated, and a narrative synthesis undertaken. RESULTS 373 articles were screened, and seven studies were included. The studies were conducted in a range of international countries which provided an overview of uro-oncology MDTs in different healthcare contexts. The following themes were identified: 1) MDT and clinical outcomes, 2) structure and format, 3) patient engagement in the process, and 4) barriers and facilitators. CONCLUSION Cancer care is constantly being challenged due to complex newer therapies, including multimodality treatments, and newer emergent broader considerations such as, oncogeriatrics, genetic counselling, and survivorship issues which should have a central place for consideration in the MDT.
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Affiliation(s)
- Blake Askelin
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
| | - Alica Hind
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.
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16
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White KM, Kwedza RK, Seale H, Harrison R. Investigating the system effect of reporting multidisciplinary care measures for cancer services in New South Wales, Australia. BMC Health Serv Res 2021; 21:1044. [PMID: 34600507 PMCID: PMC8487574 DOI: 10.1186/s12913-021-07050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures. Methods Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset. Results Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW. Conclusions The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07050-7.
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Affiliation(s)
- Kahren M White
- School of Population Health, University of New South Wales, Sydney, Australia. .,Cancer Institute NSW, Locked Bag 2030, St Leonards, NSW, 1590, Australia.
| | - Ru K Kwedza
- Cancer Institute NSW, Locked Bag 2030, St Leonards, NSW, 1590, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Reema Harrison
- School of Population Health, University of New South Wales, Sydney, Australia
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17
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Ansmann L, Heuser C, Diekmann A, Schellenberger B, Biehl C, Danaei M, Eichler C, Heinz D, Hocke A, Malter W, Melekian B, Metin H, Mustea A, Palatty J, Peisker U, Petschat I, Ernstmann N. Patient participation in multidisciplinary tumor conferences: How is it implemented? What is the patients' role? What are patients' experiences? Cancer Med 2021; 10:6714-6724. [PMID: 34402196 PMCID: PMC8495269 DOI: 10.1002/cam4.4213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Prior research has shown that around 5%-7% of patients in breast cancer centers in Germany participate in the discussion of their own case within a multidisciplinary tumor conference (MTC). The PINTU study is one of the first to research this practice. The objective is to describe (a) how patient participation in MTCs is implemented, (b) what is the role of patients, and (c) how patients experience MTCs. METHODS MTCs in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany, with and without patient participation, are studied prospectively by (non)participatory, structured observation. Breast and gynecological cancer patients completed surveys before, directly after, and 4 weeks after MTC participation. Data are analyzed descriptively. RESULTS Case discussions of a sample of n = 317 patients (n = 95 with MTC participation and n = 222 without) were observed. Survey data were obtained from n = 242 patients (n = 87 and n = 155). Observational data showed heterogeneity in the ways MTC participation was practiced. Among participating patients, 89% had the opportunity to express their opinion and 61% were involved in decision-making. Whereas most patients reported positive experiences and would recommend participation, some had negative experiences and regretted participating. CONCLUSIONS Due to a lack of recommendations, hospitals implement patient participation in MTCs in many different ways. So far, it is unknown which setting and procedures of MTC participation are beneficial for patients. However, existing evidence on communication in cancer care together with this exploratory study's findings can build the basis for developing recommendations for hospitals that invite their patients to MTCs. CLINICAL TRIAL REGISTRATION NUMBER German Clinical Trials Register Nr. DRKS00012552.
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Affiliation(s)
- Lena Ansmann
- Division for Organizational Health Services ResearchSchool of Medicine and Health SciencesUniversity of OldenburgOldenburgGermany
| | - Christian Heuser
- Department for Psychosomatic Medicine and PsychotherapyCenter for Integrated Oncology (CIO Bonn)Center for Health Communication and Health Services Research (CHSR)University Hospital BonnBonnGermany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and PsychotherapyCenter for Integrated Oncology (CIO Bonn)Center for Health Communication and Health Services Research (CHSR)University Hospital BonnBonnGermany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and PsychotherapyCenter for Integrated Oncology (CIO Bonn)Center for Health Communication and Health Services Research (CHSR)University Hospital BonnBonnGermany
| | - Claudia Biehl
- Department of Gynecology and ObstetricsWestfälisches BrustzentrumKlinikum Dortmund gGmbHDortmundGermany
| | | | - Christian Eichler
- Breast CenterDepartment of Obstetrics and GynecologyUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Dina Heinz
- Center for Gynecological and Breast CancerSt. Mary Hospital SiegenSiegenGermany
| | - Andrea Hocke
- Department of Gynecology and Gynecological OncologyUniversity Hospital BonnBonnGermany
| | - Wolfram Malter
- Breast CenterDepartment of Obstetrics and GynecologyUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Badrig Melekian
- Center for Gynecological and Breast CancerSt. Mary Hospital SiegenSiegenGermany
| | - Havva Metin
- Breast CenterMarienhospital AachenAachenGermany
| | - Alexander Mustea
- Department of Gynecology and Gynecological OncologyUniversity Hospital BonnBonnGermany
| | - Jenci Palatty
- Department of Gynecology and ObstetricsWestfälisches BrustzentrumKlinikum Dortmund gGmbHDortmundGermany
| | - Uwe Peisker
- Clinic of Gynecology, Obstetrics and SenologyBreast Cancer Center Aachen – District of HeinsbergHermann‐Josef‐HospitalErkelenzGermany
| | - Ines Petschat
- Clinic of Gynecology, Obstetrics and SenologyBreast Cancer Center Aachen – District of HeinsbergHermann‐Josef‐HospitalErkelenzGermany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and PsychotherapyCenter for Integrated Oncology (CIO Bonn)Center for Health Communication and Health Services Research (CHSR)University Hospital BonnBonnGermany
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18
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Wihl J, Rosell L, Frederiksen K, Kinhult S, Lindell G, Nilbert M. Contributions to Multidisciplinary Team Meetings in Cancer Care: Predictors of Complete Case Information and Comprehensive Case Discussions. J Multidiscip Healthc 2021; 14:2445-2452. [PMID: 34511928 PMCID: PMC8426643 DOI: 10.2147/jmdh.s309162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Multidisciplinary team (MDT) meetings integrate complex information and base recommendations for clinical management on interdisciplinary and multiprofessional decision-making. To support high-quality decision-making and define key performance indicators, we aimed to determine completeness of case information and contributions to MDT case discussions in cancer care. Methods In a prospective observational study design, based on three MDTs, we applied the Metric for Observation of Decision-Making (MODe) tool to assess the quality of case presentation and team members’ contributions to case discussions. The MDTs handled patients with brain tumors, soft tissue sarcomas and hepatobiliary cancers. The results were correlated to patient and team characteristics and to MDT leadership skills. Results Data were collected from 349 case discussions during 32 MDT meetings. Information on radiology received the highest scores, followed by case history and information on histopathology. Patient-related information was less frequently mentioned and generally received low scores. Contributions to the case discussions were predominantly by the chair, surgeons, and oncologists with limited contributions from nurses. Leadership skills showed a positive correlation with case presentations scores and failure to reach a treatment recommendation correlated with lower case discussion scores. Conclusion Considerable resources are spent on MDT meetings in cancer care, which motivate initiatives to ensure high-quality and efficient decision-making processes. We identify unbalanced contributions from team members during MDT meetings, demonstrate limited provision of patient-related information and show that leadership skills may positively influence the quality of the case presentations. We suggest that MDTs should consider and develop these aspects to ensure high-quality MDT-based case management and decision-making.
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Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Linn Rosell
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | | | - Sara Kinhult
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Danish Cancer Society Research Centre, Copenhagen, Denmark.,Clinical Research Centre, Hvidovre University Hospital and Copenhagen University, Copenhagen, Denmark
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Bohmeier B, Schellenberger B, Diekmann A, Ernstmann N, Ansmann L, Heuser C. Opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation - A qualitative interview study with providers. PATIENT EDUCATION AND COUNSELING 2021; 104:792-799. [PMID: 33051128 DOI: 10.1016/j.pec.2020.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation from the providers' perspective in breast and gynecological cancer centers. METHODS Semi-structured guideline-based expert interviews were conducted with providers from breast and gynecological cancer centers with and without patient participation in multidisciplinary tumor conferences. Interviews were transcribed, anonymized and analyzed using qualitative content analysis. RESULTS The providers (n = 30) reported that some process steps of shared decision making can be implemented in limited form and under certain conditions in multidisciplinary tumor conferences with patient participation. Above all, patients can potentially ask questions and contribute individual additional information and their preferences. CONCLUSION This study contributes first insights into the implementation of shared decision making in multidisciplinary tumor conferences with patient participation. From the providers' perspective, the implementation of shared decision making seems difficult under the current circumstances. Further studies, using patient experiences, participative observations or interventional designs, are required. PRACTICE IMPLICATIONS Despite the limited implementation of shared decision making in tumor conferences, patient participation can be advantageous as it can allow patients to ask questions and contribute individual additional information as well as their preferences.
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Affiliation(s)
- Barbara Bohmeier
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany.
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Institute for Patient Safety, University Hospital Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
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20
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Evans L, Liu Y, Donovan B, Kwan T, Byth K, Harnett P. Improving Cancer MDT performance in Western Sydney - three years' experience. BMC Health Serv Res 2021; 21:203. [PMID: 33676492 PMCID: PMC7937192 DOI: 10.1186/s12913-021-06203-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background While 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. Methods The 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. Results Twelve 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. Conclusions TPSI 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06203-y.
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Affiliation(s)
- Lynleigh Evans
- Sydney West - Translational Cancer Research Centre, Western Sydney Local Health District, PO Box 533 Wentworthville, Sydney, NSW, 2145, Australia.
| | - Yiren Liu
- Tumour Program Strengthening Initiative innovation manager (2019), Western Sydney Local Health District, Sydney, Australia
| | - Brendan Donovan
- Tumour Program Strengthening Initiative innovation manager (2018), Western Sydney Local Health District, Sydney, Australia
| | - Terence Kwan
- Faculty of Engineering and IT, University of Sydney, Sydney, Australia
| | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Sydney, Australia
| | - Paul Harnett
- Sydney West - Translational Cancer Research Centre, Western Sydney Local Health District, PO Box 533 Wentworthville, Sydney, NSW, 2145, Australia
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21
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Head and neck tumors in children and adolescents: Impact of a multidisciplinary tumor board. Oral Oncol 2021; 114:105145. [PMID: 33482589 DOI: 10.1016/j.oraloncology.2020.105145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cancer treatment in France is based on Multidisciplinary Tumor Board (MTB). In the Ile-de-France region (IDF), which includes 12 million inhabitants from Paris and the surrounding area, pediatric tumors of head and neck are discussed since 2013 in a dedicated Interregional Pediatric Multicentric MTB (IPMTB). The purpose of this study is to analyze the impact of the IDF head and neck IPMTB on the management of these tumors, 5 years after their implementation. MATERIALS AND METHODS Retrospective study of all patient files presented in the IPMTB for a benign or malignant head-and-neck tumor, between 2013 and 2018. RESULTS A total of 679 discussions were analyzed representing 428 patients. Median age was 7.5 years (range: 0-31 years). Malignant tumors represented 71% of cases, including 36% of rhabdomyosarcoma. Overall, 12% percent of the cases discussed came from centers outside of IDF. All meetings complied with multidisciplinary criteria required by French law. Proposals made during the IPMTB were followed in 86% of cases. Among the 251 proposals made by the referring teams prior to the IPMTB, 29% were secondarily modified after being discussed in the IPMTB. CONCLUSION Thanks to their multidisciplinarity, high number of cases discussed and usual respect of their proposals, the IPMTB have made it possible to improve the coordination between all specialties involved in the patient's management, to apply the most recent and scientifically validated protocols, and to share the knowledge of different teams concerning the management of particularly rare tumors.
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22
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Ries NM. Conceptualizing interprofessional working - when a lawyer joins the healthcare mix. J Interprof Care 2021; 35:953-962. [PMID: 33445987 DOI: 10.1080/13561820.2020.1856799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical-legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area.
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Affiliation(s)
- Nola M Ries
- Law
- Health
- Justice Research Centre, Faculty of Law, University of Technology Sydney, Broadway Australia
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23
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Edney LC, Gray J, Karnon J. A scoping review of the economics of multidisciplinary teams in oncology care. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Wihl J, Rosell L, Bendahl PO, De Mattos CBR, Kinhult S, Lindell G, von Steyern FV, Nilbert M. Leadership perspectives in multidisciplinary team meetings; observational assessment based on the ATLAS instrument in cancer care. Cancer Treat Res Commun 2020; 25:100231. [PMID: 33157512 DOI: 10.1016/j.ctarc.2020.100231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES High-quality leadership and chairing skills are central components in team performance during multidisciplinary team (MDT) meetings. We hypothesized that the recently developed A Tumor Leadership Assessment inStrument (ATLAS) could provide relevant information to support more detailed insights into MDT chairing and leadership aspects of relevance for team feedback and targeted improvements. MATERIALS AND METHODS The observational assessment instrument ATLAS rates chairing and leadership skills during MDT meetings in 12 predefined domains that include e.g. time management, case prioritization, team involvement, discussion climate and clarity of treatment recommendations. We used ATLAS to prospectively assess 33 MDT meetings in neuro-oncology, sarcoma and hepatobiliary cancer. RESULTS The aspects time management, effective case prioritization and provision of clear treatment plans were found to be well-functioning, whereas facilitatation of case discussions, encouragment of team member contributions, keeping the meeting focused and ability to summarize case discussions showed variable and partly weak results. CONCLUSION We conclude that the ATLAS instrument effectively captures various aspects of MDT leadership and chairing skills. It may thereby provide relevant information to prioritize initiatives that support and develop effective teamwork and decision-making during MDT meetings.
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Affiliation(s)
- Jessica Wihl
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Regional Cancer Centre South, Region Skåne, Lund, Sweden; Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden.
| | - Linn Rosell
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Regional Cancer Centre South, Region Skåne, Lund, Sweden.
| | - Pär-Ola Bendahl
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden
| | | | - Sara Kinhult
- Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Mef Nilbert
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark; Danish Cancer Society Research Centre, Copenhagen, Denmark.
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25
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Favier L, Bremaud N, Tharin Z, Blanc J, Bertaut A, Alavoine V, Dubief A, Truc G, Dorlean C, Coudert B. RCP soins de support : 12 ans d’expérience d’un centre de lutte contre le cancer. Bull Cancer 2020; 107:999-1005. [DOI: 10.1016/j.bulcan.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/29/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
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26
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Park CJ, Shaughnessy MP, Zhang L, Armenia SJ, Caty MG, Cowles RA. National Survey of Pediatric Intestinal Rehabilitation Programs in the United States. JPEN J Parenter Enteral Nutr 2020; 45:1249-1258. [PMID: 32797633 DOI: 10.1002/jpen.1997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric intestinal rehabilitation (PIR) programs are associated with improved outcomes in children with intestinal failure but remain heterogeneous nationally. This study characterizes PIR program components to aid those seeking to establish or expand a program. METHODS Members of the Children's Hospital Association reporting a PIR program to the US News and World Report completed a 14-item questionnaire using the Qualtrics Online Survey Software. Programs were categorized as small or large (≤50 vs >50 patients) and new or established (≤10 vs >10 years). RESULTS Seventy-one programs were identified and 61 surveys were returned for a response rate of 86%. Majority of programs had gastroenterology, surgery, nutrition, nursing, and social work services involved. Large programs (n = 34; 59%) were more likely to serve as referral centers; have greater participation by nursing, social work, and primary care; have more dedicated time by gastroenterology, surgery, nursing, nutrition, and social work; have more frequent meetings; and have various funding sources (P < .05). CONCLUSION Critical components of a PIR program include gastroenterology, surgery, and nutrition services with strong nursing and social work support. These data document the components of modern PIR programs, though further studies on the relationship between program structure and patient outcomes are warranted.
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Affiliation(s)
- Christine J Park
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
| | - Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
| | - Lucy Zhang
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
| | - Sarah J Armenia
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
| | - Michael G Caty
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
| | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery at Yale University, New Haven, Connecticut, 06510, USA
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27
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Reyes Veliz A, Gray J, Karnon J. Economics of multidisciplinary teams in oncology: a scoping review protocol. JBI Evid Synth 2020; 18:1285-1291. [PMID: 32813376 DOI: 10.11124/jbisrir-d-19-00103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this scoping review is to summarize the current literature on resource use, costs and economic evaluations of multidisciplinary teams in the field of oncology. INTRODUCTION Multidisciplinary teams are commonly considered best practice and are in widespread use in the field of oncology. However, multidisciplinary teams are expensive to provide, requiring significant clinician time and health care resources. Their effectiveness varies according to the type of cancer and stage of disease, and their cost-effectiveness has not been clearly established. INCLUSION CRITERIA Papers reporting on the costs of using multidisciplinary teams for the treatment of patients with cancer (at any age, level of care and in any country) will be included in the review. Costs may include the costs or resources used to provide the multidisciplinary teams (e.g. teleconference equipment, travel-time and clinician-time) or subsequent medical or non-medical costs of care. METHODS Databases, including PubMed, Embase, Cochrane Library, and the NHS Economic Evaluation Database (NHS EED), will be searched from inception. Citations and references of included studies will also be searched. Two reviewers will undertake title and abstract screening, followed by full text screening. Data extraction will be conducted using a customized form. Included studies will be summarized using narrative synthesis structured around intervention characteristics and the type of economic data presented. Additional narrative synthesis will be considered for specific subgroups (depending on numbers and variation).
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Affiliation(s)
- Amanda Reyes Veliz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jodi Gray
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Centre for Research Excellence in Implementation Science in Oncology, Macquarie University, Sydney, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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28
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Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9:1667-1679. [PMID: 32953540 PMCID: PMC7481625 DOI: 10.21037/tlcr.2019.11.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.
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Affiliation(s)
- Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth A Fradgley
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, New South Wales, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, New South Wales, Australia.,School of Medicine & Public Health, University Drive, Callaghan, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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29
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Huynh MA, Roldan C, Nunes P, Kelly A, Taylor A, Richards C, Fareed MM, Gorman D, Groff M, Ferrone M, Lu Y, Chi JH, Spektor A, Balboni T. Characteristics of Patients and Treatment Recommendations from a Multidisciplinary Spinal Tumor Program. Palliat Med Rep 2020; 1:143-148. [PMID: 34223468 PMCID: PMC8241365 DOI: 10.1089/pmr.2020.0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: We describe characteristics of patient and treatment recommendations from a spinal tumor board at one institution, including representation from palliative care. Background: The impact of prospective multidisciplinary input for patients with spinal tumors is poorly understood despite their increasing complexity. Methods: We retrospectively reviewed 622 cases sequentially discussed at a weekly spinal tumor board, and abstracted patient and treatment information from the medical record and meeting minutes. Results: From April 2017 to February 2019, 622 cases representing 438 unique patients were discussed. The median age was 62 years (range 21–92). Most patients had spinal tumors originating from metastases (91.78%), including breast (14.3%), nonsmall cell lung cancer (13.4%), prostate (10.9%), and renal cell cancer (8.8%), and the remainder had primary central nervous system (4.3%) or benign tumors (3.9%). Sixty-five percent of patients were alive at last follow-up. Conventional external beam radiotherapy was the most common treatment recommendation (33.8%) followed by surgery (26.2%), stereotactic body radiation therapy (17.8%), imaging follow-up (16.6%), and vertebroplasty (15.9%). Palliative care was the primary treatment recommended for 4.5%, and no therapy recommended for 4.0%. Treatment recommendation involved two modalities for 29% of cases, and three in 1.3% of cases. In four cases, biopsy to confirm pathology changed management due to unexpected findings of osteomyelitis, hematopoiesis, or new diagnosis of plasmacytoma. Conclusions: Multidisciplinary input is integral to the optimal care of spinal tumor patients. The high risk of death highlights the need to prioritize modalities that optimize quality of life in the context of a patient's individual prognosis.
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Affiliation(s)
- Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
- Address correspondence to: Mai Anh Huynh, MD, PhD, Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis Street, ASB-I L2, Boston, MA 02115, USA,
| | - Claudia Roldan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Paula Nunes
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Andrea Kelly
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Allison Taylor
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Cara Richards
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - M. Mohsin Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Daniel Gorman
- Department of Adult Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Groff
- Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Marco Ferrone
- Department of Orthopedic Surgery, and Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - John H. Chi
- Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Tracy Balboni
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
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30
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Takes RP, Halmos GB, Ridge JA, Bossi P, Merkx MAW, Rinaldo A, Sanabria A, Smeele LE, Mäkitie AA, Ferlito A. Value and Quality of Care in Head and Neck Oncology. Curr Oncol Rep 2020; 22:92. [PMID: 32651680 PMCID: PMC7351804 DOI: 10.1007/s11912-020-00952-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. RECENT FINDINGS This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.
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Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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31
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Karas PL, Rankin NM, Stone E. Medicolegal Considerations in Multidisciplinary Cancer Care. JTO Clin Res Rep 2020; 1:100073. [PMID: 33225316 PMCID: PMC7333617 DOI: 10.1016/j.jtocrr.2020.100073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
Health professionals participating in multidisciplinary team (MDT) cancer meetings may not be aware of their medicolegal obligations. This commentary aims to identify medicolegal issues concerning multidisciplinary cancer care and provides recommendations for future implementation. Predominant medicolegal issues related to MDT care were identified in the literature; these include patient consent and privacy at MDT meetings, professional liability, formal expression of dissenting views, and duty of care. Analysis of the literature prioritizes several recommendations for managing these issues. With limited precedent on which to base recommendations, this article identifies the formative evidence that may guide the management of these issues in future MDT practice.
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Affiliation(s)
- Pamela L Karas
- Kinghorn Cancer Centre, St Vincent's Hospital Sydney, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Emily Stone
- Kinghorn Cancer Centre, St Vincent's Hospital Sydney, University of New South Wales, Darlinghurst, New South Wales, Australia.,Department of Thoracic Medicine, St Vincent's Hospital Sydney, University of New South Wales, Darlinghurst, New South Wales, Australia
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Pilgrim CHC, Te Marvelde L, Stuart E, Croagh D, Deutscher D, Nikfarjam M, Lee B, Christophi C. Population-based analysis of treatment patterns and outcomes for pancreas cancer in Victoria. ANZ J Surg 2020; 90:1677-1682. [PMID: 32347639 DOI: 10.1111/ans.15721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/03/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Victorian Pancreas Cancer summit 2017 analysed state-wide data on management of Victorians with pancreas cancer between 2011 and 2015 to identify variations in care and outcomes. Pancreas cancer remains a formidable disease but systemic therapies are increasingly effective. Surgery remains essential but insufficient alone for cure. Understanding patterns of care and identifying variations in treatment is critical to improving outcomes. METHODS This population-based study analysed data collected prospectively by Department of Health and Human services (Victorian state government). Data were extracted from Victorian Cancer Registry (covering all Victorian cancer diagnoses), Victorian Admitted-Episodes Dataset (all inpatient data), Victorian Radiotherapy Minimum Dataset and Victorian Death Index providing demographics, tumour and treatment characteristics, age-standardized incidence, overall and median survival. RESULTS Of 3962 Victorian patients with any form of pancreatic malignancy, 82% were ductal adenocarcinoma (PDAC), of whom 67% had metastases at diagnosis. One-year overall survival for PDAC was 30% (60% non-metastatic, 15% if metastatic). Median survival with metastases increased from 2.7 to 3.9 months, and from 13.3 to 15.9 months for non-metastatic PDAC between 2011 and 2015. Thirty-one percent of non-metastatic patients underwent pancreatectomy. About 1.5% were treated with neoadjuvant chemotherapy/chemoradiation. Of patients undergoing intended curative resection, 77% proceeded to adjuvant therapy. Fifty-one percent of metastatic PDAC patients never received anti-tumour therapy. CONCLUSIONS Nearly one-fourth of surgically treated patients never received systemic therapy. More than two-thirds of non-metastatic patients never proceeded to surgery. Further consideration of neoadjuvant therapy should be given to borderline resectable patients. Most patients with PDAC still die soon after diagnosis, but median survival is increasing.
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Affiliation(s)
- Charles H C Pilgrim
- Hepatopancreaticobiliary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Cabrini Medical Centre, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Luc Te Marvelde
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Cancer Strategy & Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Ella Stuart
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Cancer Strategy & Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Dan Croagh
- Department of Surgery, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
| | - David Deutscher
- Department of Surgery, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Mehrdad Nikfarjam
- Division of Surgery, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Lee
- Walter and Eliza Hall Institute, University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Christophi
- Division of Surgery, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Salindera S, Ogilvy M, Spillane A. What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand? Breast 2020; 51:94-101. [PMID: 32252005 PMCID: PMC7375651 DOI: 10.1016/j.breast.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To evaluate BreastSurgANZ members’ compliance at various threshold rates for 4 evaluable High-Quality Performance Indicators (HQPIs) introduced to improve patient care. To benchmark global best practice to assist in determining the eventual threshold standards. Method BreastSurgANZ Quality Audit data 2012–2016 & 2018 was used to determine rates of attainment through a range of thresholds for 4 HQPI’s. Rates were assessed for different volume surgeons and comparison made to international standards. Results 1.3761 patients needing mastectomy for in situ disease, if the threshold rate for immediate breast reconstruction (IBR) was ≥ 40% then 30% of all members and 78% of very high-volume surgeons achieved that rate, which is comparable to international recommendations. 2.26,007 patients requiring mastectomy, if the threshold rate for IBR was ≥ 20% then 28% of all surgeons and 78% very high-volume surgeons met the standard. This is below most international recommendations. 3. For 31,698 invasive tumours ≤ 2 cm, if the threshold rate for breast conservation was ≥ 70% then 64% of all surgeons met the standard; 70% is comparable internationally. 4.1382 women =<50 years if the threshold rate for neoadjuvant chemotherapy was set at ≥ 15% then 36% of surgeons complied; 15% is below most international recommendations. Conclusions Even at these modest thresholds there are low levels of achievement by BreastSurgANZ members with high volume surgeons more likely to comply. These thresholds are either comparable or lower than globally accepted standards. Members should strive to meet, even exceed these important goals as they are a metric of improved patient care. High quality performance indicators are important for driving improvements in care. Our threshold standards for IBR for insitu disease are comparable internationally. Threshold indicators for invasive breast cancer are well below international standards. Members are achieving internationally comparable rates of breast conservation. Use of neoadjuvant chemotherapy for women <50yrs is below international standards.
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Affiliation(s)
| | - Michelle Ogilvy
- Mortality & Morbidity Audits, Royal Australasian College of Surgeons, Australia
| | - Andrew Spillane
- University of Sydney, Royal North Shore Hospital Sydney, Australia; Surgical Oncology at the Poche Centre, Suite 2, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia.
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Rosell L, Wihl J, Nilbert M, Malmström M. Health Professionals' Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study. J Multidiscip Healthc 2020; 13:179-186. [PMID: 32103978 PMCID: PMC7029585 DOI: 10.2147/jmdh.s240140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Multidisciplinary team meetings (MDTMs) are an integral component of cancer care. Increasingly, virtual MDTMs are used to grant high-quality treatment recommendations across health-care regions, which expands and develops the local MDTM team to a regional or national expert network. We investigated health professionals' experiences from national, virtual MDTMs for rare cancer with a focus on key enabling factors and barriers. Methods Health professionals who participate in seven national, virtual MDTMs in Swedish health-care responded to a questionnaire exploring key enabling factors, barriers and opportunities for MDTM development. Conventional content analysis was used to identify thematic categories based on free-text responses. Results Participants´ perspectives could be assigned into three categories ie, a national arena with potential for comprehensive knowledge and collaboration, prerequisites for decision-making and organization and responsibilities. These categories consisted of nine sub-categories that referred to, eg, collective competence, resources, clinical research, case discussion, meeting climate, patient-related information, MDTMs potential, referral and technical insufficiencies. Conclusion National, virtual MDTMs represent a new multidisciplinary collaborative arena that introduces benefits as well as challenges. Consideration of key enabling factors and barriers may ease implementation and further optimize MDTMs in cancer care.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden
| | - Jessica Wihl
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark.,Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Marlene Malmström
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Health Sciences, Lund, Sweden
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Rangabashyam M, Wee HE, Wang W, Mueller S, Karim KABA, Skanthakumar T, Hariraman B, Sommat K, Soong Y, Chua MLK, Tay G, Tan N‐C, Tan HK, Iyer NG. Electronic tumor board presentations as the basis for the development of a head and neck cancer database. Laryngoscope Investig Otolaryngol 2020; 5:46-54. [PMID: 32128430 PMCID: PMC7042654 DOI: 10.1002/lio2.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/27/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multidisciplinary team meetings or tumor boards (TBs) form a pivotal component of oncology practice. The crux of a TB revolves around making treatment decisions based on succinct head and neck cancer (HNC) patient data presentations, which can be challenging and complex. Apart from meticulous TB presentations, discussions and treatment plan documentation is equally important. The aim of this study was to structure an electronic synoptic TB data presentation to address all these areas. The overarching benefits of systematic TB data collection include facilitating audits and research. METHODS We utilized a secure web-based tool that was used for common scientific research purposes but customized to store HNC patient data. The data points were tabulated across eight TB pages: (a) TB scheduling, (b) patient biodata, (c) diagnosis details, (d) index presentation, (e) images, (f) management and histopathology, (g) TB presentation, and (h) TB discussion and decisions. Each data point leads to additional fields by branching logic to permit further relevant data entry. This was integrated within the patient electronic medical records allowing for a direct internal trajectory to recall TB data. RESULTS From October 2015 to October 2018, we recorded over 2000 presentations for 1279 individual patients. This is a quality improvement initiative, and hence, the results are more of a broad analysis of our TB presentation process. The most common cancers were squamous cell (523, 41%), thyroid (207, 16%), and nasopharyngeal (139, 11%) carcinomas. Importantly, this system has formed the basis for a number of clinical and translational research projects and audit outcomes. CONCLUSION Despite TBs being vital to oncologic practice, little attempt has been made to report TB data management. In this study, we present an efficient system that permits the integration of dual functions: TB data presentation and oncologic data collection for research, recall, and audit purposes.
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Affiliation(s)
- Mahalakshmi Rangabashyam
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
| | - Hide E. Wee
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
| | | | - Stefan Mueller
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
| | - Khairul A. B. A. Karim
- Clinical and Research Database Registry, Surgery Academic Clinical Program (ACP), Singapore General HospitalSingapore
| | | | | | - Kiattisa Sommat
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Yoke‐Lim Soong
- Duke‐NUS Medical SchoolSingapore
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Melvin L. K. Chua
- Duke‐NUS Medical SchoolSingapore
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Gerald Tay
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
| | - Ngian ‐Chye Tan
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Hiang Khoon‐ Tan
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
| | - N. Gopalakrishna Iyer
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
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36
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Molokwu CN, Naqvi T, Tyson D. Multidisciplinary team management of patients with urological cancer. Br J Hosp Med (Lond) 2019; 80:699-702. [PMID: 31822178 DOI: 10.12968/hmed.2019.80.12.699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Several specialist teams are involved in the management of patients with urological cancer. These specialists have been brought together as a multidisciplinary team to discuss, plan and deliver care to patients in an effective, patient-centred approach. This article discusses the benefits of this approach and ways in which multidisciplinary team working can be optimized.
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Affiliation(s)
- C N Molokwu
- Consultant Uro-Oncology Surgeon, Department of Urology, Bradford Teaching Hospitals, Bradford BD9 6RJ
| | - T Naqvi
- Urology Ward Manager, Department of Urology, Bradford Teaching Hospitals, Bradford
| | - D Tyson
- Lead Clinical Nurse Specialist, Department of Urology, Bradford Teaching Hospitals, Bradford
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37
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Stone E, Rankin NM, Vinod SK, Nagarajah M, Donnelly C, Currow DC, Fong KM, Phillips JL, Shaw T. Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study. Asia Pac J Clin Oncol 2019; 16:45-55. [PMID: 31721458 DOI: 10.1111/ajco.13278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022]
Abstract
AIM Multidisciplinary team (MDT) meetings can facilitate optimal lung cancer care, yet details of structured data collection and feedback remain sparse. This study aimed to investigate data collection and the impact of feedback to lung cancer MDTs. METHODS A mixed-methods study using pre and post-test surveys, semistructured interviews, and observation to evaluate data collection and response to modeled data feedback in three Australian lung cancer MDTs at different locations and development stage (site A: outer metropolitan, established; site B, outer metropolitan, new; and site C, inner metropolitan, established). RESULTS MDT attendees (range 13-25) discussed 5-8 cases per meeting. All sites collected data prospectively (80% prepopulated) into local oncology medical information systems. The pretest survey had 17 respondents in total (88% clinicians). At sites A and C, 100% of respondents noted regular data audits, occasional at site B. Regular audit data included number of cases, stage, final diagnosis, and time to diagnosis and treatment. The post-test survey had 25 respondents in total, all clinicians. The majority (88-96%) of respondents found modeled data easy to interpret, relevant to clinical practice and the MDT, and welcomed future regular data presentations (as rated on a 5-point Likert scale mean weighted average 4.5 where > 4 demonstrates agreement). Semistructured interviews identified five major themes for MDTs: current practice, attitudes, enablers, barriers, and benefits for the MDT. CONCLUSIONS MDT teams exhibited positive responses to modeled data feedback. Key characteristics of MDT data were identified and may assist with future team research and development.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole M Rankin
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Mohan Nagarajah
- Department of Respiratory and Sleep Medicine, Blacktown Hospital, Western Sydney University, Sydney, New South Wales, Australia
| | - Candice Donnelly
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, Charles Perkins Centre, University of Sydney and Sydney West Translational Cancer Research Centre, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Shaw
- Director of Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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38
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Nic Giolla Easpaig B, Arnolda G, Tran Y, Bierbaum M, Lamprell K, Delaney GP, Liauw W, Chittajallu R, Winata T, Ward RL, Currow DC, Olver I, Karnon J, Westbrook J, Braithwaite J. What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector. BMJ Open 2019; 9:e031179. [PMID: 31601594 PMCID: PMC6797275 DOI: 10.1136/bmjopen-2019-031179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients' supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. METHODS AND ANALYSIS A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients' needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. ETHICS AND DISSEMINATION Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.
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Affiliation(s)
- Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Geoffrey P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
- University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Winston Liauw
- Saint George Hospital Saint George Cancer Care Centre, Kogarah, New South Wales, Australia
- Saint George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - David C Currow
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ian Olver
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Hoinville L, Taylor C, Zasada M, Warner R, Pottle E, Green J. Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members' opinions about streamlining patient discussions. BMJ Open Qual 2019; 8:e000631. [PMID: 31259288 PMCID: PMC6567952 DOI: 10.1136/bmjoq-2019-000631] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cancer is diagnosed and managed by multidisciplinary teams (MDTs) in the UK and worldwide, these teams meet regularly in MDT meetings (MDMs) to discuss individual patient treatment options. Rising cancer incidence and increasing case complexity have increased pressure on MDMs. Streamlining discussions has been suggested as a way to enhance efficiency and to ensure high-quality discussion of complex cases. Methods Secondary analysis of quantitative and qualitative data from a national survey of 1220 MDT members regarding their views about streamlining MDM discussions. Results The majority of participants agreed that streamlining discussions may be beneficial although variable interpretations of ‘streamlining’ were apparent. Agreement levels varied significantly by tumour type and occupational group. The main reason for opposing streamlining were concerns about the possible impact on the quality and safety of patient care. Participants suggested a range of alternative approaches for improving efficiency in MDMs in addition to the use of treatment protocols and pre-MDT meetings. Conclusions This work complements previous analyses in supporting the development of tumour-specific guidance for streamlining MDM discussions considering a range of approaches. The information provided about the variation in opinions between MDT for different tumour types will inform the development of these guidelines. The evidence for variation in opinions between those in different occupational groups and the reasons underlying these opinions will facilitate their implementation. The impact of any changes in MDM practices on the quality and safety of patient care requires evaluation.
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Affiliation(s)
- Linda Hoinville
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Magda Zasada
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Ross Warner
- Department of Urology, Leicester General Hospital, Leicester, UK
| | - Emma Pottle
- GKT School of Medical Education, King's College London School of Medical Education, London, UK
| | - James Green
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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40
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Evans L, Donovan B, Liu Y, Shaw T, Harnett P. A tool to improve the performance of multidisciplinary teams in cancer care. BMJ Open Qual 2019; 8:e000435. [PMID: 31259279 PMCID: PMC6567949 DOI: 10.1136/bmjoq-2018-000435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/12/2019] [Accepted: 05/06/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction 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 adopted an innovative methodology to assess multidisciplinary team performance and engage teams in performance improvement strategies. Methods The study comprised a survey to evaluate MDT members’ perceptions of their team’s performance before the implementation of the programme and annually thereafter, and a maturity matrix designed as a self-assessment tool. Each MDT used the matrix to collectively assess its performance and identify areas for improvement. Results In the first cycle, 180 member surveys from 19 MDTs were completed. This provided insights into team members’ perceptions of performance. 12 of these teams continued with the study and all 12 completed the matrix. Most teams rated themselves at level one or two (low) on a scale of five for most items. Conclusions The MDT survey and maturity matrix have the potential to be useful for cancer care teams to identify their strengths and weaknesses and monitor performance over time and also for management to review its performance against standard criteria and to identify priority areas for improvement and further support.
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Affiliation(s)
- Lynleigh Evans
- Western Sydney Local Health District, Sydney West-Translational Cancer Research Centre, Westmead, New South Wales, Australia.,Western Sydney Local Health District, Sydney West Cancer Network, Sydney, New South Wales, Australia
| | - Brendan Donovan
- Western Sydney Local Health District, Crown Princess Mary Cancer Centre at Westmead Hospital, Sydney, New South Wales, Australia
| | - Yiren Liu
- Western Sydney Local Health District, Crown Princess Mary Cancer Centre at Westmead Hospital, Sydney, New South Wales, Australia
| | - Tim Shaw
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Western Sydney Local Health District, Sydney West-Translational Cancer Research Centre, Sydney, New South Wales, Australia
| | - Paul Harnett
- Western Sydney Local Health District, Sydney West Cancer Network, Sydney, New South Wales, Australia.,Sydney West-Translational Cancer Research Centre, Sydney, New South Wales, Australia
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Lamprell K, Arnolda G, Delaney GP, Liauw W, Braithwaite J. The challenge of putting principles into practice: Resource tensions and real‐world constraints in multidisciplinary oncology team meetings. Asia Pac J Clin Oncol 2019; 15:199-207. [DOI: 10.1111/ajco.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Klay Lamprell
- Centre for Healthcare Resilience and Implementation ScienceAustralian Institute of Health InnovationMacquarie University NSW Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation ScienceAustralian Institute of Health InnovationMacquarie University NSW Australia
| | - Geoff P. Delaney
- South West Sydney Local Health District NSW Australia
- Liverpool Hospital Liverpool NSW Australia
- University of NSW and Ingham Institute of Applied Medical Research NSW Australia
| | - Winston Liauw
- Cancer Services Stream South Eastern Sydney Local Health District NSW Australia
- Cancer Care Centre St George Hospital NSW Australia
- St George and Sutherland Clinical SchoolUniversity of New South Wales NSW Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation ScienceAustralian Institute of Health InnovationMacquarie University NSW Australia
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Rosell L, Wihl J, Hagberg O, Ohlsson B, Nilbert M. Function, information, and contributions: An evaluation of national multidisciplinary team meetings for rare cancers. Rare Tumors 2019; 11:2036361319841696. [PMID: 31105919 PMCID: PMC6506921 DOI: 10.1177/2036361319841696] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/12/2019] [Indexed: 12/24/2022] Open
Abstract
National virtual multidisciplinary team meetings have been established in Swedish
cancer care in response to centralized treatment of rare cancers. Though
national meetings grant access to a large multidisciplinary network, we
hypothesized that video-based meetings may challenge participants’ contributions
to the case discussions. We investigated participants’ views and used
observational tools to assess contributions from various health professionals
during the multidisciplinary team meetings. Data on participants’ views were
collected using an electronic survey distributed to participants in six national
multidisciplinary team meetings for rare cancers. Data from observations were
obtained from the multidisciplinary team meetings for penile cancer, anal
cancer, and vulvar cancer using the standardized observational tools Meeting
Observational Tool and Metric of Decision-Making that assess multidisciplinary
team meeting functionality and participants’ contributions to the case
discussions. Participants overall rated the multidisciplinary team meetings
favorably with high scores for development of individual competence and team
competence. Lower scores applied to multidisciplinary team meeting technology,
principles for communicating treatment recommendations, and guidelines for
evaluating the meetings. Observational assessment resulted in high scores for
case histories, leadership, and teamwork, whereas patient-centered care and
involvement of care professionals received low scores. National virtual
multidisciplinary team meetings are feasible and receive positive ratings by the
participants. Case discussions cover medical perspectives well, whereas
patient-centered aspects achieve less attention. Based on these findings, we
discuss factors to consider to further improve treatment recommendations from
national multidisciplinary team meetings.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Division of Oncology and Pathology, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jessica Wihl
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Oskar Hagberg
- Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Björn Ohlsson
- Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Mef Nilbert
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
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