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

Multidisciplinary approach for hepatocellular carcinoma patients: current evidence and future perspectives

Management of hepatocellular carcinoma (HCC) is challenging due to the complex relationship between underlying liver disease, tumor burden, and liver function. HCC is also notorious for its high recurrence rate even after curative treatment for early-stage tumor. Liver transplantation can substantially alter patient prognosis, but donor availability varies by each patient which further complicates treatment decision. Recent advancements in HCC treatments have introduced numerous potentially efficacious treatment modalities. However, high level evidence comparing the risks and benefits of these options is limited. In this complex situation, multidisciplinary approach or multidisciplinary team care has been suggested as a valuable strategy to help cope with escalating complexity in HCC management. Multidisciplinary approach involves collaboration among medical and health care professionals from various academic disciplines to provide comprehensive care. Although evidence suggests that multidisciplinary care can enhance outcomes of HCC patients, robust data from randomized controlled trials are currently lacking. Moreover, the implementation of a multidisciplinary approach necessitates increased medical resources compared to conventional cancer care. This review summarizes the current evidence on the role of multidisciplinary approach in HCC management and explores potential future directions.

To Study the Effect of Individualized Nursing Model Based on MDT Concept on Limb Function Recovery and Quality of Life in Patients with Breast Cancer

Objective

To study the value of the individualized nursing model based on the concept of multidisciplinary team (MDT) on recovery of limb function and quality of life in patients with breast cancer.

Methods

A total of 110 breast cancer patients admitted to our hospital from January 2021 to December 2021 were selected as the research objects. The 110 breast cancer patients were divided into the research group (n = 55) and the control group (n = 55) according to the random number table method. The control group received routine care. The research group implemented individualized nursing based on the MDT concept on the basis of routine nursing. The disabilities of the arm, shoulder, and hand (DASH) scores before nursing and 1 month after nursing were studied in the two groups, Hamilton anxiety scale (HAMA) score, Hamilton depression scale (HAMD) score, and Functional Assessment of Cancer Therapy-B (FACT-B) score.

Results

After 1 month of nursing, the DASH score of the research group was lower than that of the control group, and the difference was statistically significant (P < 0.05), and after 1 month of nursing, the HAMA score of the research group was lower than that of the control group (P < 0.05). After 1 month of nursing, the HAMD scale score of the research group was lower than that of the control group, and the difference was statistically significant (P < 0.05). After 1 month of nursing, the FACT-B score of the research group was higher than that of the control group, and the difference was statistically significant (P < 0.05).

Conclusion

The individualized nursing model based on the MDT concept has high application value for breast cancer patients. This nursing model can improve the function of limb movement, relieve the patient's anxiety and depression, and improve the patient's quality of life. This nursing model is worthy of clinical promotion.

Process Evaluation of the Regional Referral Clinical Pathway for Home-Based Palliative Care and Outreach Program: A Questionnaire Survey of the Medical Staff and Bereaved Families

Background: The purpose of this study was to clarify how the Regional Referral Clinical Pathway for Home-based Palliative Care (RRCP-HPC) and an outreach program by a palliative care team (PCT) lead to an improvement in the outcome. Design and Methods: We conducted questionnaire surveys using the mailing method involving the regional medical staff involved in cancer patients introduced to the PCT of a single hospital, as well as bereaved families. The questionnaire was prepared through interviews with the medical staff and bereaved families. Subsequently, factor analysis was performed to identify factor structures and calculate the correlation coefficient with each outcome. Results: For the questionnaire survey involving the medical staff, responses were collected from 119 regional medical institutions and 84 regional medical staff. The response rate per institution was 51.3%. Similarly, for the questionnaire survey involving bereaved families, the response rate was 42.4%. For the survey involving the medical staff, 6 factors, such as “improved awareness of an interdisciplinary team,” were extracted. For the survey involving the bereaved families, 4 factors, such as “improvement of communications between patients and healthcare professionals,” were extracted. There were significant (≥moderate) correlations between these factors and all outcomes. Conclusion: In this study, we clarified the process of achieving palliative care until death at home without difficulties using the outreach program and RRCP-HPC. The results suggest the importance of improving communications. The outreach program and RRCP-HPC may have contributed to palliative care at home without difficulties through an improvement in communications.

Multidisciplinary Team Management of Hepatocellular Carcinoma Is Standard of Care

Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality, but unlike other leading causes of cancer death, HCC is increasing in mortality and burden of management. Management of HCC is unique because it usually arises in a diseased liver, which itself may be a driver of mortality. Multidisciplinary teams (MDTs) for the management of complex diseases are becoming more common, but are especially needed in the management of patients with HCC. Liver cancer MDTs are used in most centers providing comprehensive care for patients with HCC, and should be considered the standard of care for these patients.

Evaluation of A Novel Information-Sharing Instrument for Home-Based Palliative Care: A Feasibility Study

Aim:

To examine the feasibility and usefulness of a novel region-based pathway: the Regional Referral Clinical Pathway for Home-Based Palliative Care.

Method:

This was a feasibility study to evaluate the frequency of variances and the perceived usefulness of pathway using in-depth interviews. All patients with cancer referred to the palliative care team between 2011 and 2013 and received home care services were enrolled.

Result:

A total of 44 patients were analyzed, and pathway was completed in all the patients. The target outcome was achieved in 61.4% while some variances occurred in 54.5%. Nine categories were identified as the usefulness of the pathway, such as reviewing and sharing information and promoting communication, education, motivation, and relationships.

Conclusion:

This novel pathway is feasible and seems to be useful.