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Hollingsworth E, Shields BH, Rutter C, Fox L, Evans KN, Willging JP, Drake AF. Improving Craniofacial Team Collaboration: A Multicenter Interview Study of Effective Team Meetings. J Multidiscip Healthc 2024; 17:3589-3603. [PMID: 39070687 PMCID: PMC11283780 DOI: 10.2147/jmdh.s457581] [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: 03/03/2024] [Accepted: 06/11/2024] [Indexed: 07/30/2024] Open
Abstract
Objective In the USA, the American Cleft Palate Association-Craniofacial Association (ACPA-CPF) specifies guidelines to ensure craniofacial teams function in a multidisciplinary fashion to provide care in a sequence that mirrors the patient's needs. Among these guidelines is the expectation that teams hold regular multidisciplinary team meetings to discuss patient care. The purpose of this study was to identify factors that contribute to optimal team functioning during these meetings. The impact of the virtual format on meetings was also evaluated. Design One-hour semi-structured interviews of craniofacial team members, queried on current and ideal team meetings, were conducted from December 2020 - January 2021. Interviews were recorded, transcribed, and coded to identify common themes until thematic saturation was achieved. Setting/Participants Sixteen team members from three major American craniofacial centers were interviewed virtually. Results Three major categories were identified as integral to successful meetings: (1) meeting content, (2) meeting processes, and (3) team dynamics. Within these categories are several factors that participants reported as important to optimize their multidisciplinary meetings: key content for discussions, integration of patient perspective, recognition of collaboration in determining proper sequence of treatments, an attentive discussion leader promoting equitable discussions, managing absences, and team diversity. Participants also identified benefits and pitfalls of hosting meetings in the virtual setting, including lack of engagement and awkward communication. Conclusion Diverse groups of disciplines are expected to come together during craniofacial multidisciplinary meetings to formulate intricate care plans for complex patients. In this study, craniofacial team members have identified several key factors to optimize these meetings. The research group used these factors to propose a self-evaluation instrument for meeting quality improvement, provided in printable format. Further studies should evaluate how implementation of these factors affects meetings and ultimately guides patient care.
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Affiliation(s)
- Elexis Hollingsworth
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin H Shields
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Rutter
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Lynn Fox
- Adams School of Dentistry, UNC Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kelly N Evans
- Division of Craniofacial Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Jay Paul Willging
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA
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Jones TS, Mckown L, Lane A, Horney C, Unruh M, Brown N, Sommerville-Henderson S, Jones EL, Albright K, Levy C, Robinson T. Patient Participation in Multidisciplinary High-Risk Surgery Discussions: A Pilot Study. J Palliat Med 2024; 27:912-915. [PMID: 38973547 DOI: 10.1089/jpm.2023.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Objective: Our medical center implemented a multidisciplinary team to improve surgical decision making for high-risk older adults. To make this a patient-centric process, a pilot program included the patient and their family/caregiver(s) in these conversations. Our hypothesis is that multidisciplinary team discussions can improve difficult surgical decision making. Methods: From January to June 2022, we offered patients and their family participation in multidisciplinary discussions at a Veterans Affairs medical center. Semistructured interviews were conducted 1-6 days after the meeting. Interview transcripts were analyzed with qualitative mixed-methods approach. Results: Six patients and caregivers participated in the interviews. They found the discussion helpful for improving their understanding of the surgical decision. Out of these, 50% (3 of 6) of the patients changed their decision regarding the planned operation based on the discussion. Conclusion: Including patients and caregiver(s) in multidisciplinary surgical decision-making discussions resulted in half of the patients changing their surgical plans. This pilot study demonstrated both acceptance and feasibility for all participants.
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Affiliation(s)
- Teresa S Jones
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Lauren Mckown
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Seattle-Denver Center for Innovation (COIN), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Amber Lane
- Seattle-Denver Center for Innovation (COIN), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Carolyn Horney
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Morgan Unruh
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Nathaniel Brown
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Edward L Jones
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Karen Albright
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Cari Levy
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Thomas Robinson
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
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Daye D, Parker R, Tripathi S, Cox M, Brito Orama S, Valentin L, Bridge CP, Uppot RN. CASCADE: Context-Aware Data-Driven AI for Streamlined Multidisciplinary Tumor Board Recommendations in Oncology. Cancers (Basel) 2024; 16:1975. [PMID: 38893096 PMCID: PMC11171258 DOI: 10.3390/cancers16111975] [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: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
This study addresses the potential of machine learning in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). Using an IRB-approved retrospective study of patients discussed at a multidisciplinary tumor board, clinical and imaging variables were extracted and used in a gradient-boosting machine learning algorithm, XGBoost. The algorithm's performance was assessed using confusion matrix metrics and the area under the Receiver Operating Characteristics (ROC) curve. The study included 140 patients (mean age 67.7 ± 8.9 years), and the algorithm was found to be predictive of all eight treatment recommendations made by the board. The model's predictions were more accurate than those based on published therapeutic guidelines by ESMO and NCCN. The study concludes that a machine learning model incorporating clinical and imaging variables can predict treatment recommendations made by an expert multidisciplinary tumor board, potentially aiding clinical decision-making in settings lacking subspecialty expertise.
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Affiliation(s)
- Dania Daye
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | | | - Satvik Tripathi
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | - Meredith Cox
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
| | | | - Leonardo Valentin
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Professional Hospital Guaynabo, Guaynabo 00971, Puerto Rico
| | - Christopher P. Bridge
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | - Raul N. Uppot
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
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Guowei CHE, Qinghua ZHOU. [Current Situation and Future Direction of Multidisciplinary Diagnosis
and Treatment of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:325-329. [PMID: 38880919 PMCID: PMC11183311 DOI: 10.3779/j.issn.1009-3419.2024.102.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Indexed: 06/18/2024]
Abstract
Although multidisciplinary team (MDT) diagnosis and treatment model can improve the quality of life and survival prognosis of the patients, why does it not reach the expected goal of the MDT diagnosis and treatment model? The main reason is that the diagnosis and treatment mode of MDT in lung cancer lags behind the progress of various treatment methods. By analyzing the latest research results of MDT diagnosis and treatment of lung cancer at home and abroad, combined with the experience of MDT diagnosis and treatment of lung cancer in the Lung Cancer Center of West China Hospital of Sichuan University, this article will discuss and summarize the progress and future direction of MDT in lung cancer from the following aspects: (1) The connotation and extension of MDT diagnosis and treatment mode of lung cancer need to be changed and adapted to new methods of diagnosis and treatment; (2) The clinical decision making in the diagnosis and treatment of MDT in lung cancer should be transformed from "multidisciplinary consultation (MDC)" to "MDT"; (3) The diagnosis and treatment process of MDT in lung cancer should shift from "fire brigade mode" to "firewall mode", and finally implement "individualized whole-process management mode"; (4) The path of MDT diagnosis and treatment of lung cancer should be changed from "temporary convening mode" to "single disease center system mode of lung cancer".
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Degenhardt M, Ernstmann N, Schellenberger B, Ansmann L, Heuser C. Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach. Cancer Med 2024; 13:e7199. [PMID: 38800961 PMCID: PMC11129163 DOI: 10.1002/cam4.7199] [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: 11/27/2023] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined. METHODS This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. RESULTS A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers. CONCLUSION Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.
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Affiliation(s)
- Marie Degenhardt
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
| | - Lena Ansmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Medical SociologyCologneGermany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
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Morabito A, Mercadante E, Muto P, Manzo A, Palumbo G, Sforza V, Montanino A, Sandomenico C, Costanzo R, Esposito G, Totaro G, Cecio RD, Picone C, Porto A, Normanno N, Capasso A, Pinto M, Tracey M, Caropreso G, Pascarella G. Improving the quality of patient care in lung cancer: key factors for successful multidisciplinary team working. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:260-277. [PMID: 38751383 PMCID: PMC11093720 DOI: 10.37349/etat.2024.00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/08/2024] [Indexed: 05/18/2024] Open
Abstract
International Guidelines as well as Cancer Associations recommend a multidisciplinary approach to lung cancer care. A multidisciplinary team (MDT) can significantly improve treatment decision-making and patient coordination by putting different physicians and other health professionals "in the same room", who collectively decide upon the best possible treatment. However, this is not a panacea for cancer treatment. The impact of multidisciplinary care (MDC) on patient outcomes is not univocal, while the effective functioning of the MDT depends on many factors. This review presents the available MDT literature with an emphasis on the key factors that characterize high-quality patient care in lung cancer. The study was conducted with a bibliographic search using different electronic databases (PubMed Central, Scopus, Google Scholar, and Google) referring to multidisciplinary cancer care settings. Many key elements appear consolidated, while others emerge as prevalent and actual, especially those related to visible barriers which work across geographic, organizational, and disciplinary boundaries. MDTs must be sustained by strategic management, structured within the entity, and cannot be managed as a separate care process. Furthermore, they need to coordinate with other teams (within and outside the organization) and join with the broad range of services delivered by multiple providers at various points of the cancer journey or within the system, with the vision of integrated care.
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Affiliation(s)
- Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Edoardo Mercadante
- Thoracic Surgery, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuliano Palumbo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Claudia Sandomenico
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Raffaele Costanzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giovanna Esposito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuseppe Totaro
- Radiotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Rossella De Cecio
- Pathology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Carmine Picone
- Radiology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Annamaria Porto
- Radiology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Nicola Normanno
- Cellular Biology and Biotherapy, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Arturo Capasso
- WSB Merito University in Wroclaw, Fabryczna 29-31, 53-609 Wroclaw, Poland
| | - Monica Pinto
- Rehabilitative Medicine Unit, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Maura Tracey
- Rehabilitative Medicine Unit, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giuseppe Caropreso
- Division of Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Giacomo Pascarella
- Scientific Directorate, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
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Lee CY, Lai HY, Lee CH, Chen MM, Yau SY. Collaborative clinical reasoning: a scoping review. PeerJ 2024; 12:e17042. [PMID: 38464754 PMCID: PMC10924455 DOI: 10.7717/peerj.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. Methods A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. Results A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. Conclusions While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Mi-Mi Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- (CG-MERC) Chang Gung Medical Education Research Centre, Linkou, Taoyuan, Taiwan
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Soriano GP, Calong Calong KA, Martinez RCKP, Ito H, Yasuhara Y, Abalos EA, Tanioka T. Development and psychometric properties of the Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines. BELITUNG NURSING JOURNAL 2023; 9:512-519. [PMID: 37901374 PMCID: PMC10600707 DOI: 10.33546/bnj.2906] [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: 08/19/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
Background Over the years, a few tools and instruments have been developed to assist in the assessment within a palliative care setting. However, many of these tools and instruments do not reflect a person-centered palliative care model. Objective This study aims to develop a Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines. Methods An exhaustive search of the literature was conducted to develop a pool of items for the instrument. The validity of the instrument was evaluated using the content validity index (CVI), while the factor structure was assessed using exploratory factor analysis (EFA) using maximum likelihood estimation with Promax rotation. Also, the internal reliability was evaluated using Cronbach's alpha. Results EFA yielded three factors: 1) Caring as maintaining person's dignity (13 items), 2) caring as empowerment of person's autonomy (14 items), and 3) caring as understanding person's momentary concerns (10 items). Whereas the internal consistency reliability of these subscales appeared excellent (i.e., 0.95, 0.96, and 0.93, respectively), the Cronbach's alpha for the overall scale was 0.98. The item-total correlation coefficients were >0.30 for all items, ranging from 0.310 to 0.726. Conclusion Findings support a three-factor, 37-item PPCNI that can be used in clinical practice to ensure that nurses provide palliative care based on patient needs and preferences.
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Affiliation(s)
- Gil P. Soriano
- Graduate School of Health Sciences, Tokushima University, Tokushima, Japan
- College of Allied Health, Department of Nursing, National University Philippines
| | | | | | - Hirokazu Ito
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yuko Yasuhara
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | | | - Tetsuya Tanioka
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Vernooij JEM, Boerlage RM, Doggen CJM, Preckel B, Dirksen CD, van Leeuwen BL, Spruit RJ, Festen S, van der Wal-Huisman H, van Basten JP, Kalkman CJ, Koning NJ. Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study-a multicenter stepped-wedge cluster randomized trial. Trials 2023; 24:660. [PMID: 37821994 PMCID: PMC10568883 DOI: 10.1186/s13063-023-07685-3] [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: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. METHODS/DESIGN PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. DISCUSSION PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.
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Affiliation(s)
- Jacqueline E M Vernooij
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Romijn M Boerlage
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carmen D Dirksen
- Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rutger J Spruit
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean P van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nick J Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
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Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
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Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
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Del Rio P, Polistena A, Chiofalo MG, De Pasquale L, Dionigi G, Docimo G, Graceffa G, Iacobone M, Medas F, Pezzolla A, Sorrenti S, Spiezia S, Calò PG. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg 2023; 75:1393-1417. [PMID: 37198359 PMCID: PMC10435599 DOI: 10.1007/s13304-023-01522-7] [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: 12/30/2022] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - M G Chiofalo
- Department Head and Neck, Thyroid Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - L De Pasquale
- Thyroid and Parathyroid Service, Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - G Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G Docimo
- Division of Thyroid Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - G Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplanatation, University of Bari "A. Moro", Bari, Italy
| | - S Sorrenti
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - S Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, Ospedale del Mare, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Murray S, Subbiah V, Sherman SI, Péloquin S, Sireci A, Grohé C, Bubach P, Lazure P. Challenges in the care of patients with RET-altered thyroid cancer: a multicountry mixed-methods study. Thyroid Res 2023; 16:22. [PMID: 37574538 PMCID: PMC10424354 DOI: 10.1186/s13044-023-00166-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/02/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The discovery of driver oncogenes for thyroid carcinomas and the identification of genomically targeted therapies to inhibit those oncogenes have altered the treatment algorithm in thyroid cancer (TC), while germline testing for RET mutations has become indicated for patients with a family history of RET gene mutations or hereditary medullary TC (MTC). In the context of an increasing number of selective RET inhibitors approved for use, this paper aims to describe challenges and barriers affecting providers' ability to deliver optimal care for patients with RET-altered TC across the patient healthcare journey. METHODS A mixed-method educational and behavioral needs assessment was conducted in Germany (GER), Japan (JPN), the United Kingdom (UK), and the United States (US) prior to RET-selective inhibitor approval. Participants included medical oncologists (MO), endocrinologists (EN) and clinical pathologists (CP) caring for patients affected with TC. Data collection tools were implemented in three languages (English, German, Japanese). Qualitative data were coded and thematically analyzed in NVivo. Quantitative data were analyzed via frequency and crosstabulations in SPSS. The findings presented here were part of a broader study that also investigated lung cancer challenges and included pulmonologists. RESULTS A total of 44 interviews and 378 surveys were completed. Suboptimal knowledge and skills were self-identified among providers, affecting (1) assessment of genetic risk factors (56%, 159/285 of MOs and ENs), (2) selection of appropriate genetic biomarkers (59%, 53/90 of CPs), (3) treatment plan initiation (65%, 173/275 of MOs and ENs), (4) management of side effects associated with multitargeted tyrosine kinase inhibitors (78%, 116/149 of MOs and ENs), and (5) transfer of patients into palliative care services (58%, 160/274 of MOs and ENs). Interviews underscored the presence of systemic barriers affecting the use of RET molecular tests and selective inhibitors, in addition to suboptimal knowledge and skills necessary to manage the safety and efficacy of targeted therapies. CONCLUSION This study describes concrete educational needs for providers involved in the care of patients with RET-altered thyroid carcinomas. Findings can be used to inform the design of evidence-based education and performance improvement interventions in the field and support integration into practice of newly approved RET-selective inhibitors.
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Affiliation(s)
- Suzanne Murray
- AXDEV Group Inc, 210-8, Place du Commerce, Brossard, Québec, J4W 3H2, Canada.
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Steven I Sherman
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Sophie Péloquin
- AXDEV Group Inc, 210-8, Place du Commerce, Brossard, Québec, J4W 3H2, Canada
| | - Anthony Sireci
- Eli Lilly, 450 E 29th St 12th Floor, New York, NY, 10016, USA
| | - Christian Grohé
- Berlin Evangelical Lung Clinic, Lindenberger Weg 27, 13125, Berlin, Germany
| | - Patrick Bubach
- Eli Lilly, 450 E 29th St 12th Floor, New York, NY, 10016, USA
| | - Patrice Lazure
- AXDEV Group Inc, 210-8, Place du Commerce, Brossard, Québec, J4W 3H2, Canada
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Anokwute MC, Preda V, Di Ieva A. Determining Contemporary Barriers to Effective Multidisciplinary Team Meetings in Neurological Surgery: A Review of the Literature. World Neurosurg 2023; 172:73-80. [PMID: 36754351 DOI: 10.1016/j.wneu.2023.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The integration of multidisciplinary team meetings (MDTMs) for neurosurgical care has been accepted worldwide. Our objective was to review the literature for the limiting factors to MDTMs that may introduce bias to patient care. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to perform a literature review of MDTMs for neuro-oncology, pituitary oncology, cerebrovascular surgery, and spine surgery and spine oncology. Limiting factors to productive MDTMs and factors that introduce bias were identified, as well as determining whether MDTMs led to improved patient outcomes. RESULTS We identified 1264 manuscripts from a PubMed and Ovid Medline search, of which 27 of 500 neuro-oncology, 4 of 279 pituitary, and 11 of 260 spine surgery articles met our inclusion criteria. Of 224 cerebrovascular manuscripts, none met the criteria. Factors for productive MDTMs included quaternary/tertiary referral centers, nonhierarchical environment, regularly scheduled meetings, concise inclusion of nonmedical factors at the same level of importance as patient clinical information, inclusion of nonclinical participants, and use of clinical guidelines and institutional protocols to provide recommendations. Our review did not identify literature that described the use of artificial intelligence to reduce bias and guide clinical care. CONCLUSIONS The continued implementation of MDTMs in neurosurgery should be recommended but cautioned by limiting bias.
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Affiliation(s)
- Miracle C Anokwute
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Veronica Preda
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Antonio Di Ieva
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Computational NeuroSurgery (CNS) Lab, Macquarie University, Sydney, New South Wales, Australia.
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Zasada M, Harris J, Groothuizen J, Aroyewun E, Mendis J, Taylor C, Hewish M. Investigating the efficiency of lung multi-disciplinary team meetings-A mixed methods study of eight lung multi-disciplinary teams. Cancer Med 2023; 12:9999-10007. [PMID: 36934449 PMCID: PMC10166965 DOI: 10.1002/cam4.5730] [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: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs), where treatment recommendations are discussed and agreed, are fundamental to effective cancer care. The increasing volume and complexity of caseloads has led to the need to transform MDTM pathways to improve efficiency and allow sufficient time for discussion of complex cases. Understanding of current functioning and inefficiencies is required to inform such transformation. METHODS A mixed-methods observational study of all lung cancer MDTMs in one UK cancer network over 12 weeks (n = 8 MDTs, 96 MDT meetings). Data were collected on meeting attendance and on each discussed case using a validated MDT tool. Semi-structured interviews were conducted with a range of MDT members and cancer service managers to gain understanding of perceived influences on the efficiency of MDTMs. RESULTS In total, 1671 case discussions were observed. Models of MDT working, including referral and diagnostic pathway management, varied within the network. Attendance was quorate in only 21% of the observed MDTMs, most often lacking palliative care specialists. Over a third (37%) of observed cases were repeat discussions pre-diagnosis. Treatment recommendations were agreed in 48% of case discussions but deferred for a quarter (24%) of discussed cases, most commonly due to awaiting results. Information about patients' fitness for treatment and/or performance status score was available for 60% of cases discussed overall (30%-75% by MDT). Interviews (n = 56) identified addressing clinical and administrative workforce shortages, less reliance on the MDTM for pre-diagnostic decision-making and better availability of key clinical information about patients discussed in the MDTM as factors critical to improved MDT function. CONCLUSIONS Inefficiencies were prevalent in all MDTMs; improvements would require an individualised approach due to the variation in ways of working. Local, regional and national support is needed for lung MDTs to develop their diagnostic workforce and facilities, and clinical and administrative resource.
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Affiliation(s)
| | - Jenny Harris
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Eunice Aroyewun
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Jeewaka Mendis
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [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: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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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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Walraven JEW, van der Meulen R, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Hesselink G, Desar IME. Preparing tomorrow's medical specialists for participating in oncological multidisciplinary team meetings: perceived barriers, facilitators and training needs. BMC MEDICAL EDUCATION 2022; 22:502. [PMID: 35761247 PMCID: PMC9238222 DOI: 10.1186/s12909-022-03570-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/20/2022] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists. METHODS Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants' demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis. RESULTS Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents' MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills. CONCLUSION Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences.
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Affiliation(s)
- Janneke E W Walraven
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands.
| | - Renske van der Meulen
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
| | - Jacobus J M van der Hoeven
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
| | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands
- Department of Medical Oncology, Cancer Centers Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Gijs Hesselink
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, huispost 707, 6500, HB, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
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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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Ankolekar A, van der Heijden B, Dekker A, Roumen C, De Ruysscher D, Reymen B, Berlanga A, Oberije C, Fijten R. Clinician perspectives on clinical decision support systems in lung cancer: Implications for shared decision-making. Health Expect 2022; 25:1342-1351. [PMID: 35535474 PMCID: PMC9327823 DOI: 10.1111/hex.13457] [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: 03/12/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Lung cancer treatment decisions are typically made among clinical experts in a multidisciplinary tumour board (MTB) based on clinical data and guidelines. The rise of artificial intelligence and cultural shifts towards patient autonomy are changing the nature of clinical decision‐making towards personalized treatments. This can be supported by clinical decision support systems (CDSSs) that generate personalized treatment information as a basis for shared decision‐making (SDM). Little is known about lung cancer patients' treatment decisions and the potential for SDM supported by CDSSs. The aim of this study is to understand to what extent SDM is done in current practice and what clinicians need to improve it. Objective To explore (1) the extent to which patient preferences are taken into consideration in non‐small‐cell lung cancer (NSCLC) treatment decisions; (2) clinician perspectives on using CDSSs to support SDM. Design Mixed methods study consisting of a retrospective cohort study on patient deviation from MTB advice and reasons for deviation, qualitative interviews with lung cancer specialists and observations of MTB discussions and patient consultations. Setting and Participants NSCLC patients (N = 257) treated at a single radiotherapy clinic and nine lung cancer specialists from six Dutch clinics. Results We found a 10.9% (n = 28) deviation rate from MTB advice; 50% (n = 14) were due to patient preference, of which 85.7% (n = 12) chose a less intensive treatment than MTB advice. Current MTB recommendations are based on clinician experience, guidelines and patients' performance status. Most specialists (n = 7) were receptive towards CDSSs but cited barriers, such as lack of trust, lack of validation studies and time. CDSSs were considered valuable during MTB discussions rather than in consultations. Conclusion Lung cancer decisions are heavily influenced by clinical guidelines and experience, yet many patients prefer less intensive treatments. CDSSs can support SDM by presenting the harms and benefits of different treatment options rather than giving single treatment advice. External validation of CDSSs should be prioritized. Patient or Public Contribution This study did not involve patients or the public explicitly; however, the study design was informed by prior interviews with volunteers of a cancer patient advocacy group. The study objectives and data collection were supported by Dutch health care insurer CZ for a project titled ‘My Best Treatment’ that improves patient‐centeredness and the lung cancer patient pathway in the Netherlands.
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Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Britt van der Heijden
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cary Oberije
- The D-Lab, GROW School for Oncology, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
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21
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Ichikawa M, Uematsu K, Yano N, Yamada M, Ono T, Kawashiro S, Akamatsu H, Hagiwara Y, Sato H, Nemoto K. Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: an observational study at a single Japanese institution. BMC Med Inform Decis Mak 2022; 22:111. [PMID: 35477440 PMCID: PMC9044833 DOI: 10.1186/s12911-022-01849-y] [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: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan. METHODS This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs. RESULTS A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician's opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs. CONCLUSIONS MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient's preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.
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Affiliation(s)
- Mayumi Ichikawa
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan.
| | - Ken Uematsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Natsuko Yano
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Masayoshi Yamada
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Shohei Kawashiro
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiroko Akamatsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Yasuhito Hagiwara
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiraku Sato
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
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22
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Brown GTF, Bekker HL, Young AL. Quality and efficacy of Multidisciplinary Team (MDT) quality assessment tools and discussion checklists: a systematic review. BMC Cancer 2022; 22:286. [PMID: 35300636 PMCID: PMC8928609 DOI: 10.1186/s12885-022-09369-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This reviews aims to describe and appraise these tools, as well as consider their value to quality improvement. Methods Medline, EMBASE and PsycInfo were searched using pre-defined terms. The PRISMA model was followed throughout. Studies were included if they described the development of a relevant tool, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results The search returned 7930 results. 18 studies were included. In total 7 tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2 to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions Several tools for assessment and guidance of MDTs are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement. Trial registration PROSPERO ID: CRD42021234326. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09369-8.
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Affiliation(s)
- George T F Brown
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development, School of Medicine, University of Leeds, Leeds, UK.,Research Centre for Patient Involvement, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alastair L Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK.
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23
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Tran TH, de Boer J, Gyorki DE, Krishnasamy M. Optimising the quality of multidisciplinary team meetings: A narrative review. Cancer Med 2022; 11:1965-1971. [PMID: 35257515 PMCID: PMC9089217 DOI: 10.1002/cam4.4432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/08/2022] Open
Abstract
Background Understanding of factors that contribute to implementation of effective cancer multidisciplinary team meetings (MDMs) is still limited. Published literature on the effect of teamwork function, leadership roles, decision‐making processes and structural components on the quality of MDMs was reviewed and synthesised. Methods In this paper, a MEDLINE review (September 2020) was performed to assess clinical decision‐making in the context of MDM discussions. Results Twenty‐nine eligible studies were included. Six studies addressed the infrastructural aspects of MDMs. Nine studies used either qualitative or mixed method approach to develop and validate observational tools to assess the quality of MDMs. Seven studies used qualitative approaches to explore the opinions of MDM members on factors that impact on the effectiveness of MDMs. Five studies used validated observational tools to observe and assess the effectiveness of MDMs. One prospective study explored the relationship between quality of information presented at MDMs and ability of MDM members to make clinical decisions. The final study prospectively tested the ability of a multicomponent intervention to improve decision‐making processes within MDMs. Conclusions A broad range of factors including teamwork, leadership, case complexity, decision‐making processes and availability of patient information were identified to impact the quality of MDMs. Evidence currently available largely focuses on the development of tools to identify factors in need of improvement to optimise MDMs. Robust research is required to identify the factors that are demonstrated to enhance MDM quality which can then aid the standardisation of how MDMs are conducted.
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Affiliation(s)
- Thanh Hai Tran
- University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jasper de Boer
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - David E Gyorki
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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24
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Perspectives on record-keeping practices in MDT meetings and meeting record utility. Int J Med Inform 2022; 161:104711. [DOI: 10.1016/j.ijmedinf.2022.104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
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25
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Scholl I, Hahlweg P, Lindig A, Frerichs W, Zill J, Cords H, Bokemeyer C, Coym A, Schmalfeldt B, Smeets R, Vollkommer T, Witzel I, Härter M, Kriston L. Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial. Implement Sci 2021; 16:106. [PMID: 34965881 PMCID: PMC8715412 DOI: 10.1186/s13012-021-01174-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is preferred by many patients in cancer care. However, despite scientific evidence and promotion by health policy makers, SDM implementation in routine health care lags behind. This study aimed to evaluate an empirically and theoretically grounded implementation program for SDM in cancer care. METHODS In a stepped wedge design, three departments of a comprehensive cancer center sequentially received the implementation program in a randomized order. It included six components: training for health care professionals (HCPs), individual coaching for physicians, patient activation intervention, patient information material/decision aids, revision of quality management documents, and reflection on multidisciplinary team meetings (MDTMs). Outcome evaluation comprised four measurement waves. The primary endpoint was patient-reported SDM uptake using the 9-item Shared Decision Making Questionnaire. Several secondary implementation outcomes were assessed. A mixed-methods process evaluation was conducted to evaluate reach and fidelity. Data were analyzed using mixed linear models, qualitative content analysis, and descriptive statistics. RESULTS A total of 2,128 patient questionnaires, 559 questionnaires from 408 HCPs, 132 audio recordings of clinical encounters, and 842 case discussions from 66 MDTMs were evaluated. There was no statistically significant improvement in the primary endpoint SDM uptake. Patients in the intervention condition were more likely to experience shared or patient-lead decision-making than in the control condition (d=0.24). HCPs in the intervention condition reported more knowledge about SDM than in the control condition (d = 0.50). In MDTMs the quality of psycho-social information was lower in the intervention than in the control condition (d = - 0.48). Further secondary outcomes did not differ statistically significantly between conditions. All components were implemented in all departments, but reach was limited (e.g., training of 44% of eligible HCPs) and several adaptations occurred (e.g., reduced dose of coaching). CONCLUSIONS The process evaluation provides possible explanations for the lack of statistically significant effects in the primary and most of the secondary outcomes. Low reach and adaptations, particularly in dose, may explain the results. Other or more intensive approaches are needed for successful department-wide implementation of SDM in routine cancer care. Further research is needed to understand factors influencing implementation of SDM in cancer care. TRIAL REGISTRATION clinicaltrials.gov, NCT03393351 , registered 8 January 2018.
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Affiliation(s)
- Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anja Lindig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jördis Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hannah Cords
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anja Coym
- II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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26
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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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27
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Gebbia V, Guarini A, Piazza D, Bertani A, Spada M, Verderame F, Sergi C, Potenza E, Fazio I, Blasi L, La Sala A, Mortillaro G, Roz E, Marchese R, Chiarenza M, Soto-Parra H, Valerio MR, Agneta G, Amato C, Lipari H, Baldari S, Ferraù F, Di Grazia A, Mancuso G, Rizzo S, Firenze A. Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer. Pulm Ther 2021; 7:295-308. [PMID: 34089169 PMCID: PMC8177259 DOI: 10.1007/s41030-021-00163-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 01/31/2023] Open
Abstract
To date, the virtual multidisciplinary tumor boards (vMTBs) are increasingly used to achieve high-quality treatment recommendations across health-care regions, which expands and develops the local MTB team to a regional or national expert network. This review describes the process of lung cancer-specific MTBs and the transition process from face-to-face tumor boards to virtual ones. The review also focuses on the project organization's description, advantages, and disadvantages. Semi-structured interviews identified five major themes for MTBs: current practice, attitudes, enablers, barriers, and benefits for the MTB. MTB teams exhibited positive responses to modeled data feedback. Virtualization reduces time spent for travel, allowing easier and timely patient discussions. This process requires a secure web platform to assure the respect of patients' privacy and presents the same unanswered problems. The implementation of vMTB also permits the implementation of networks especially in areas with geographical barriers facilitating interaction between large referral cancer centers and tertiary or community hospitals as well as easier access to clinical trial opportunities. Studies aimed to improve preparations, structure, and conduct of MTBs, research methods to monitor their performance, teamwork, and outcomes are also outlined in this article. Analysis of literature shows that MTB participants discuss 5-8 cases per meeting and that the use of a vMTB for lung cancer and in particular stage III NSCLC and complex stage IV cases is widely accepted by most health professionals. Despite still-existing gaps, overall vMTB represents a unique opportunity to optimize patient management in a patient-centered approach.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy.
- GSTU Foundation, Palermo, Italy.
| | - Aurelia Guarini
- Medical Oncology Unit, Fondazione Ospedale Giglio, Cefalù, Palermo, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS Ismett, UPMC, Palermo, Italy
| | - Massimiliano Spada
- Medical Oncology Unit, Fondazione Ospedale Giglio, Cefalù, Palermo, Italy
| | | | - Concetta Sergi
- Thoracic Surgery Unit, ARNAS, Ospedale Garibaldi, Nesima, Catania, Italy
| | - Enrico Potenza
- Thoracic Surgery Unit, ARNAS, Ospedale Garibaldi, Nesima, Catania, Italy
| | - Ivan Fazio
- Radiation Therapy Unit, Clinica Macchiarella, Palermo, Italy
| | - Livio Blasi
- Medical Oncology Unit, Arnas Civico, Palermo, Italy
| | - Alba La Sala
- Bronchial Endoscopy Unit, Arnas Civico, Palermo, Italy
| | | | - Elena Roz
- Pathology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | - Roberto Marchese
- Thoracic Surgery Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | | | | | | | - Giuseppe Agneta
- Thoracic Surgery Unit, Ospedale Cervello Villa Sofia, Palermo, Italy
| | - Carmela Amato
- Patients Advocacy "Serena a Palermo", Palermo, Italy
| | - Helga Lipari
- Medical Oncology Unit, Ospedale Cannizzaro, Catania, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, Messina, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, Ospedale San Vincenzo, Taormina, Messina, Italy
| | - Alfio Di Grazia
- Radiation Oncology Unit, Istituto Clinico Humanitas, Catania, Italy
| | - Gianfranco Mancuso
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy
| | - Sergio Rizzo
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy
| | - Alberto Firenze
- Risk Management Unit, Policlinico, University of Palermo, Palermo, Italy
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28
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Guirado M, Sanchez-Hernandez A, Pijuan L, Teixido C, Gómez-Caamaño A, Cilleruelo-Ramos Á. Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group. Clin Transl Oncol 2021; 24:446-459. [PMID: 34665437 PMCID: PMC8525055 DOI: 10.1007/s12094-021-02712-8] [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: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.
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Affiliation(s)
- M Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, 03203, Elche, Spain
| | - A Sanchez-Hernandez
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, 12002, Castellón de la Plana, Spain
| | - L Pijuan
- Pathology Department, Bellvitge University Hospital, 08907, L'Hospitalet de Llobregat, Spain
| | - C Teixido
- Thoracic Oncology Unit, Department of Pathology, IDIBAPS, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Á Cilleruelo-Ramos
- Thoracic Surgery Department, Hospital Clínico Universitario Valladolid, 47005, Valladolid, Spain
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29
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Reck S, Diekmann A, Heuser C, Schellenberger B, Ansmann L, Wirtz MA, Ernstmann N. Is patient participation in multidisciplinary tumour conferences associated with their information needs? A multicentre prospective observational study. BMJ Open 2021; 11:e049199. [PMID: 34556513 PMCID: PMC8461738 DOI: 10.1136/bmjopen-2021-049199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the association between participation of patients with breast cancer and patients with gynaecological cancer in their own multidisciplinary tumour conference (MTC) and their information needs with regard to their disease and treatment options. METHODS This is a prospective observational study that took place at six breast cancer and gynaecological cancer centres in North Rhine-Westphalia, Germany. Patient inclusion criteria included a minimum age of 18 years and at least one diagnosis of breast cancer or gynaecological cancer. Three surveys were administered. T0 (shortly before MTC), T1 (directly after MTC) and T2 (4 weeks after MTC). Patient information needs were measured using two three-item subscales of the Cancer Patients Information Needs scale. Analysis of change was done by one-way repeated measures analysis of variance (ANOVA). To control for sampling bias, a further one-way repeated measures analysis of covariance (ANCOVA) included a propensity score as a covariate. RESULTS Data from 81 patients in the participation group and 120 patients in the non-participation group were analysed. The patient groups did not differ in their levels of information needs at T0 or T2. From T0 to T2, information needs increased statistically significantly in both groups with regard to both disease-related information (η²=0.354) and treatment-related information (η²=0.250). The increase in both types of information needs lost its statistical significance when the propensity score was included as a covariate. Neither ANOVA nor ANCOVA revealed a statistically significant association between patients' participation in the MTC and their self-reported information needs. CONCLUSION AND CLINICAL IMPLICATIONS As concerns patients' information needs, findings do not support a general recommendation for or against the participation of patients in their MTCs. Future research should focus on the different ways of patients' participation in their MTCs facilitated at different cancer centres. Further research should also aim to establish which patient and disease characteristics predispose patients to benefit from participating in their MTCs.
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Affiliation(s)
- Sebastian Reck
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Department of Organizational Health Services Research, University of Oldenburg, Oldenburg, Germany
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Markus Antonius Wirtz
- Department of Research Methods, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Fenton ME, Wade SA, Pirrili BN, Balogh ZJ, Rowe CW, Bendinelli C. Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review. J Clin Med 2021; 10:4150. [PMID: 34575260 PMCID: PMC8470818 DOI: 10.3390/jcm10184150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.
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Affiliation(s)
- Mark E. Fenton
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Sarah A. Wade
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Bibi N. Pirrili
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
| | - Zsolt J. Balogh
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Christopher W. Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Endocrinology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Cino Bendinelli
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
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31
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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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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] [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 Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Claudia Biehl
- Department of Gynecology and Obstetrics, Westfälisches Brustzentrum, Klinikum Dortmund gGmbH, Dortmund, Germany
| | | | - Christian Eichler
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dina Heinz
- Center for Gynecological and Breast Cancer, St. Mary Hospital Siegen, Siegen, Germany
| | - Andrea Hocke
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Badrig Melekian
- Center for Gynecological and Breast Cancer, St. Mary Hospital Siegen, Siegen, Germany
| | - Havva Metin
- Breast Center, Marienhospital Aachen, Aachen, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Jenci Palatty
- Department of Gynecology and Obstetrics, Westfälisches Brustzentrum, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Uwe Peisker
- Clinic of Gynecology, Obstetrics and Senology, Breast Cancer Center Aachen - District of Heinsberg, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Ines Petschat
- Clinic of Gynecology, Obstetrics and Senology, Breast Cancer Center Aachen - District of Heinsberg, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
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Gomes MM, Dennie C, Laurie SA, Shamji FM. How to Design and Foster Thoracic Oncology Multidisciplinary Cancer Conferences. Thorac Surg Clin 2021; 31:229-235. [PMID: 34304831 DOI: 10.1016/j.thorsurg.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this chapter, the authors review and discuss the literature on multidisciplinary cancer conferences (MCCs, aka tumor boards), clarifying the terminology, showing the evolution of the field, and providing an evidence-based perspective on positive outcomes, best practices, factors influencing the quality of MCCs, evaluation tools to assess the quality of MCCs, and quality improvement interventions for MCCs. The authors then discuss some perspectives from their MCC and initiatives that they undertook to improve the work of their team and the care that they provide to patients in the area of thoracic oncology.
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Affiliation(s)
- Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Scott A Laurie
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Farid M Shamji
- University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
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Festen S, Nijmeijer H, van Leeuwen BL, van Etten B, van Munster BC, de Graeff P. Multidisciplinary decision-making in older patients with cancer, does it differ from younger patients? Eur J Surg Oncol 2021; 47:2682-2688. [PMID: 34127326 DOI: 10.1016/j.ejso.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In order to tailor treatment to the individual patient, it is important to take the patients context and preferences into account, especially for older patients. We assessed the quality of information used in the decision-making process in different oncological MDTs and compared this for older (≥70 years) and younger patients. PATIENTS AND METHODS Cross-sectional observations of oncological MDTs were performed, using an observation tool in a University Hospital. Primary outcome measures were quality of input of information into the discussion for older and younger patients. Secondary outcomes were the contribution of different team members, discussion time for each case and whether or not a treatment decision was formulated. RESULTS Five-hundred and three cases were observed. The median patient age was 63 year, 32% were ≥70. In both age groups quality of patient-centered information (psychosocial information and patient's view) was poor. There was no difference in quality of information between older and younger patients, only for comorbidities the quality of information for older patients was better. There was no significant difference in the contributions by team members, discussion time (median 3.54 min) or number of decision reached (87.5%). CONCLUSION For both age groups, we observed a lack of patient-centered information. The only difference between the age groups was for information on comorbidities. There were also no differences in contributions by different team members, case discussion time or number of decisions. Decision-making in the observed oncological MDTs was mostly based on medical technical information.
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Affiliation(s)
- S Festen
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - H Nijmeijer
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B van Etten
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P de Graeff
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Lamb BW, Miah S, Skolarus TA, Stewart GD, Green JSA, Sevdalis N, Soukup T. Development and Validation of a Short Version of the Metric for the Observation of Decision-Making in Multidisciplinary Tumor Boards: MODe-Lite. Ann Surg Oncol 2021; 28:7577-7588. [PMID: 33974197 PMCID: PMC8519835 DOI: 10.1245/s10434-021-09989-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
Background Evidence-based tools are necessary for scientifically improving the way MTBs work. Such tools are available but can be difficult to use. This study aimed to develop a robust observational assessment tool for use on cancer multidisciplinary tumor boards (MTBs) by health care professionals in everyday practice. Methods A retrospective cross-sectional observational study was conducted in the United Kingdom from September 2015 to July 2016. Three tumor boards from three teaching hospitals were recruited, with 44 members overall. Six weekly meetings involving 146 consecutive cases were video-recorded and scored using the validated MODe tool. Data were subjected to reliability and validity analysis in the current study to develop a shorter version of the MODe. Results Phase 1, a reduction of the original items in the MODe, was achieved through two focus group meetings with expert assessors based on previous research. The 12 original items were reduced to 6 domains, receiving full agreement by the assessors. In phase 2, the six domains were subjected to item reliability, convergent validation, and internal consistency testing against the MODe-Lite global score, the MODe global score, and the items of the MODe. Significant positive correlations were evident across all domains (p < 0.01), indicating good reliability and validity. In phase 3, feasibility and high inter-assessor reliability were achieved by two clinical assessors. Six domains measuring clinical input, holistic input, clinical collaboration, pathology, radiology, and management plan were integrated into MODe-Lite. Conclusions As an evidence-based tool for health care professionals in everyday practice, MODe-Lite gives cancer MTBs insight into the way they work and facilitates improvements in practice. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-09989-7.
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Affiliation(s)
- B W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - S Miah
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - T A Skolarus
- VA Health Service Research and Development Center for Clinical Management Research, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - G D Stewart
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - J S A Green
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.,Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - N Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - T Soukup
- Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.
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Kovács A, Bischoff P, Haddad H, Kovács G, Schaefer A, Zhou W, Pinkawa M. Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy. Front Oncol 2021; 11:616058. [PMID: 33869002 PMCID: PMC8047426 DOI: 10.3389/fonc.2021.616058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
Minimal-invasive interventions considerably extend the therapeutic spectrum in oncology and open new dimensions in terms of survival, tolerability and patient-friendliness. Through the influence of image-guided interventions, many interdisciplinary therapy concepts have significantly evolved, and this process is by far not yet over. The rapid progression of minimal-invasive technologies offers hope for new therapeutic concepts in the short, medium and long term. Image-guided hybrid-technologies complement and even replace in selected cases classic surgery. In this newly begun era of immune-oncology, interdisciplinary collaboration and the focus on individualized and patient-friendly therapies are crucial.
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Affiliation(s)
- Attila Kovács
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Peter Bischoff
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Hathal Haddad
- Clinic for Radiotherapy and Radiooncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - György Kovács
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andreas Schaefer
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Willi Zhou
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Michael Pinkawa
- Clinic for Radiotherapy and Radiooncology, MediClin Robert Janker Klinik, Bonn, Germany
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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: 9] [Impact Index Per Article: 3.0] [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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Mertens F, Debrulle Z, Lindskog E, Deliens L, Deveugele M, Pype P. Healthcare professionals' experiences of inter-professional collaboration during patient's transfers between care settings in palliative care: A focus group study. Palliat Med 2021; 35:355-366. [PMID: 33126837 DOI: 10.1177/0269216320968741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. AIM To explore healthcare professionals' experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. DESIGN Qualitative design, including focus group discussions. SETTING/PARTICIPANTS The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital's palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals (n = 53) from different care settings. RESULTS Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement.A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. CONCLUSION From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.
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Affiliation(s)
- Fien Mertens
- General Practitioner, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,VUB, Belgium.,End-of-Life Care Research Group
| | | | | | - Luc Deliens
- End-of-Life Care Research Group.,Professor of Palliative Care Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, VUB, Belgium
| | - Myriam Deveugele
- Professor em. Communication in Health Care, Psychologist, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Pype
- End-of-Life Care Research Group.,Professor Interprofessional Collaboration in Education and Practice, General Practitioner, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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39
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Adegboyega B, Irurhe K, Yakubu C, Bashir A, Ogunyemi A, Alabi A. Patients' perspective of one-stop breast clinic, Lagos University Teaching Hospital. WEST AFRICAN JOURNAL OF RADIOLOGY 2021. [DOI: 10.4103/wajr.wajr_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Heuser C, Diekmann A, Schellenberger B, Bohmeier B, Kuhn W, Karbach U, Ernstmann N, Ansmann L. Patient Participation in Multidisciplinary Tumor Conferences from the Providers' Perspective: Is It Feasible in Routine Cancer Care? J Multidiscip Healthc 2020; 13:1729-1739. [PMID: 33273821 PMCID: PMC7708776 DOI: 10.2147/jmdh.s283166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Recent studies from Germany show that a small amount of breast and gynecological cancer patients participate in multidisciplinary tumor conferences (MTCs) at some cancer centers. One reason for the variation by center might be the providers’ attitudes about and experiences with MTC patient participation (MTCpp), which has not been analyzed before. Therefore, it is the aim of this study to analyze the providers’ expected or experienced feasibility concerning MTCpp at breast and gynecological cancer centers in Germany. Methods This paper presents cross-sectional qualitative interview data from the PINTU study. From April to December 2018, n=30 health-care providers from n=6 breast and gynecological cancer centers in North-Rhine-Westphalia, Germany, were interviewed. One-half of the providers had no experience and the other half had experience with MTCpp. Inductive and deductive coding was performed in order to capture the feasibility aspects of participation. Results MTCpp seems not to be feasible in routine cancer care following providers’ expected barriers and negative experiences. However, MTCpp seems to be feasible for selected cancer patients following providers’ expected opportunities and positive experiences. Our results show that both provider groups report positive and negative experiences or expectations. Conclusion The mixed findings regarding expected or experienced feasibility of MTCpp provide first insights into differences concerning MTCpp between organizations. Our results suggest that the providers’ perceptions (expectations and experiences) influence the possibility for patients to participate in an MTC in a cancer center.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Bohmeier
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Walther Kuhn
- Gynecological Cancer Center Deggendorf, DONAUISAR Hospital, Deggendorf, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Chung R, Rosenkrantz AB, Shanbhogue KP. Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management. Abdom Radiol (NY) 2020; 45:3800-3808. [PMID: 32444889 DOI: 10.1007/s00261-020-02587-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To identify the frequency, source, and management impact of discrepancies between the initial radiology report and expert reinterpretation occurring in the context of a hepatobiliary multidisciplinary tumor board (MTB). METHODS This retrospective study included 974 consecutive patients discussed at a weekly MTB at a large tertiary care academic medical center over a 2-year period. A single radiologist with dedicated hepatobiliary imaging expertise attended all conferences to review and discuss the relevant liver imaging and rated the concordance between original and re-reads based on RADPEER scoring criteria. Impact on management was based on the conference discussion and reflected changes in follow-up imaging, recommendations for biopsy/surgery, or liver transplant eligibility. RESULTS Image reinterpretation was discordant with the initial report in 19.9% (194/974) of cases (59.8%, 34.5%, 5.7% RADPEER 2/3/4 discrepancies, respectively). A change in LI-RADS category occurred in 59.8% of discrepancies. Most common causes of discordance included re-classification of a lesion as benign rather than malignant (16.0%) and missed tumor recurrence (13.9%). Impact on management occurred in 99.0% of discordant cases and included loco-regional therapy instead of follow-up imaging (19.1%), follow-up imaging instead of treatment (17.5%), and avoidance of biopsy (12.4%). 11.3% received OPTN exception scores due to the revised interpretation, and 8.8% were excluded from listing for orthotopic liver transplant. CONCLUSION Even in a sub-specialized abdominal imaging academic practice, expert radiologist review in the MTB setting identified discordant interpretations and impacted management in a substantial fraction of patients, potentially impacting transplant allocation. The findings may impact how abdominal imaging sections best staff advanced MTBs.
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Affiliation(s)
- Ryan Chung
- Department of Radiology, NYU Langone Health, 660 First Ave, New York, NY, 10016, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Health, 660 First Ave, New York, NY, 10016, USA
| | - Krishna P Shanbhogue
- Department of Radiology, NYU Langone Health, 660 First Ave, New York, NY, 10016, USA.
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Berardi R, Morgese F, Rinaldi S, Torniai M, Mentrasti G, Scortichini L, Giampieri R. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res 2020; 12:9363-9374. [PMID: 33061625 PMCID: PMC7533227 DOI: 10.2147/cmar.s220976] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
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Affiliation(s)
- Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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43
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Baes S, Horlait M, Dhaene S, Leys M. Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology. INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520959678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.
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Affiliation(s)
- S Baes
- Vrije Universiteit Brussel, Belgium
| | | | - S Dhaene
- AZ Sint-Elisabeth Ziekenhuis, Belgium
| | - M Leys
- Vrije Universiteit Brussel, Belgium
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Kowalski C, Albert US, Baumann W, Carl EG, Ernstmann N, Hermes-Moll K, Fallenberg EM, Feick G, Feiten S, Härter M, Heidt V, Heuser C, Hübner J, Joos S, Katalinic A, Kempkens Ö, Kerek-Bodden H, Klinkhammer-Schalke M, Koller M, Langer T, Lehner B, Lux MP, Maatouk I, Pfaff H, Ratsch B, Schach S, Scholl I, Skoetz N, Voltz R, Wiskemann J, Inwald E. [DNVF Memorandum Health Services Research in Oncology]. DAS GESUNDHEITSWESEN 2020; 82:e108-e121. [PMID: 32858754 DOI: 10.1055/a-1191-3759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health services research in oncology deals with all situations which cancer patients face. It looks at the different phases of care, i. e. prevention / early detection, prehabilitation, diagnostics, therapy, rehabilitation and palliative care as well as the various actors, including those affected, the carers and self-help. It deals with healthy people (e. g. in the context of prevention / early detection), patients and cancer survivors. Due to the nature of cancer and the existing care structures, there are a number of specific contents for health services research in oncology compared to general health services research while the methods remain essentially identical. This memorandum describes the subject, illustrates the care structures and identifies areas of health services research in oncology. This memorandum has been prepared by the Oncology Section of the German Network for Health Services Research and is the result of intensive discussions.
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Affiliation(s)
| | | | - Walter Baumann
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO GmbH), Köln
| | - Ernst-Günther Carl
- Haus der Krebsselbsthilfe, Bonn.,Bundesverband Prostatakrebs Selbsthilfe, Bonn
| | - Nicole Ernstmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung, Universitätsklinikum Bonn, Bonn.,Zentrum für Integrierte Onkologie, Universitätsklinikum Bonn, Bonn.,Institut für Patientensicherheit, Universitätsklinikum Bonn, Bonn
| | - Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO GmbH), Köln
| | - Eva Maria Fallenberg
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, München
| | | | - Stefan Feiten
- Institut für Versorgungsforschung in der Onkologie GbR, Koblenz
| | - Martin Härter
- Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Vitali Heidt
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO GmbH), Köln
| | - Christian Heuser
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung, Universitätsklinikum Bonn, Bonn.,Zentrum für Integrierte Onkologie, Universitätsklinikum Bonn, Bonn
| | - Joachim Hübner
- Zentrum für Bevölkerungsmedizin und Versorgungsforschung, Universität zu Lübeck, Lübeck
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University of Tübingen Faculty of Science, Tübingen
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck.,Institut für Krebsepidemiologie e.V., Universität zu Lübeck, Lübeck
| | | | | | - Monika Klinkhammer-Schalke
- Institut für Qualitätssicherung und Versorgungsforschung, Tumorzentrum Regensburg, Universität Regensburg, Regensburg.,Institut for Quality Assurance and Health Services Research, Tumorcenter Regensburg, University of Regensburg, Regensburg
| | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg
| | | | - Burkhard Lehner
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Heidelberg, Heidelberg
| | - Michael P Lux
- Frauen- und Kinderklinik St. Louise, St. Vincenz-Krankenhaus, Paderborn
| | - Imad Maatouk
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg
| | | | - Boris Ratsch
- Market Access & Public Affairs, Takeda Pharma Vertrieb GmbH & Co KG, Berlin
| | | | - Isabelle Scholl
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Nicole Skoetz
- Zentrum für integrierte Onkologie, Universitätsklinik Köln
| | | | - Joachim Wiskemann
- Nationales Zentrum für Tumorerkrankungen Heidelberg, Heidelberg.,UniversitätsKlinikum Heidelberg, Heidelberg
| | - Elisabeth Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Regensburg, Regensburg
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A national audit of radiology practice in cancer multidisciplinary team meetings. Clin Radiol 2020; 75:640.e17-640.e27. [DOI: 10.1016/j.crad.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/18/2020] [Indexed: 11/24/2022]
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46
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Hendriks MP, Verbeek XAAM, van Manen JG, van der Heijden SE, Go SHL, Gooiker GA, van Vegchel T, Siesling S, Jager A. Clinical decision trees support systematic evaluation of multidisciplinary team recommendations. Breast Cancer Res Treat 2020; 183:355-363. [PMID: 32627108 PMCID: PMC7383031 DOI: 10.1007/s10549-020-05769-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
Purpose EUSOMA’s recommendation that “each patient has to be fully informed about each step in the diagnostic and therapeutic pathway” could be supported by guideline-based clinical decision trees (CDTs). The Dutch breast cancer guideline has been modeled into CDTs (www.oncoguide.nl). Prerequisites for adequate CDT usage are availability of necessary patient data at the time of decision-making and to consider all possible treatment alternatives provided in the CDT. Methods This retrospective single-center study evaluated 394 randomly selected female patients with non-metastatic breast cancer between 2012 and 2015. Four pivotal CDTs were selected. Two researchers analyzed patient records to determine to which degree patient data required per CDT were available at the time of multidisciplinary team (MDT) meeting and how often multiple alternatives were actually reported. Results The four selected CDTs were indication for magnetic resonance imaging (MRI) scan, preoperative and adjuvant systemic treatment, and immediate breast reconstruction. For 70%, 13%, 97% and 13% of patients, respectively, all necessary data were available. The two most frequent underreported data-items were “clinical M-stage” (87%) and “assessable mammography” (28%). Treatment alternatives were reported by MDTs in 32% of patients regarding primary treatment and in 28% regarding breast reconstruction. Conclusion Both the availability of data in patient records essential for guideline-based recommendations and the reporting of possible treatment alternatives of the investigated CDTs were low. To meet EUSOMA’s requirements, information that is supposed to be implicitly known must be explicated by MDTs. Moreover, MDTs have to adhere to clear definitions of data-items in their reporting.
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Affiliation(s)
- Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Xander A A M Verbeek
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Jeannette G van Manen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Sannah E van der Heijden
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Shirley H L Go
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Gea A Gooiker
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Thijs van Vegchel
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer. J Geriatr Oncol 2020; 11:909-916. [DOI: 10.1016/j.jgo.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
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Charoui C, Souadka A, Saber S, Latib R, Rifai L, Amrani L, Benkabbou A, Mohsine R, Majbar MA. Evaluation of the Decision-Making Mode during Digestive Oncology Multidisciplinary Meetings: a Prospective Study in a Moroccan Center. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2020. [DOI: 10.46327/msrjg.1.000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.
Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients' point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).
Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.
Keywords: Decision making, Quality improvement, Multidisciplinary Concertation meeting, MDT-MODe, Morocco
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49
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Charoui C, Souadka A, Saber S, Latib R, Rifai L, Amrani L, Benkabbou A, Mohsine R, Majbar MA. Evaluation of the Decision-Making Mode during Digestive Oncology Multidisciplinary Meetings: a Prospective Study in a Moroccan Center. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2020. [DOI: 10.46327/msrjg.1.000000000000169bis] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.
Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients' point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).
Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.
Keywords: Decision making, Quality improvement, Multidisciplinary Concertation meeting, MDT-MODe, Morocco
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50
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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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