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Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study.

ABSTRACT: BACKGROUND:Tumor boards (TB) play an important role to formulate a management plan for the treatment of patients with a malignancy. Recent evidence suggests that optimally functioning teams (teamwork, communication and decision making) are major prerequisites to conduct efficient TB meetings. The aims of this study were i) to use a readily published tool as a template for the development of a teamwork perspective extended assessment tool and ii) to evaluate the tool in a feasibility study by clinical and non-clinical observers. METHODS:A systematic literature search in four databases revealed the "Metric for the Observation of Decision-making (MODe)" to be consistently used. MODe served as a template for the clinical evaluation, additional, notably teamwork items were integrated, and the resulting tool was tested in a feasibility study in TBs by clinical and non-clinical observers. The percentage of agreement between observers was assessed in a two-step approach: first, agreement of raters on discussion of items by TB members, and second, agreement of raters based on ordinal scale. RESULTS:In total, 244 patients were discussed in 27 TB sessions, thereof 136 (56%) fast track cases and 108 (44%) complex cases. In 228 (93%) of all cases an agreement for recommendation of a treatment plan was reached. Observers showed in general high agreement on discussion of the items. For the majority of items, the percentage of agreement between the different pairs of rater was similar and mostly high. CONCLUSION:A newly developed TB team performance tool using MODe as a template was piloted in a German-speaking country and enabled the assessment of specialized multidisciplinary teams with a special focus on teamwork patterns. The developed assessment tool requires evaluation in a larger collective for validation, and additional assessment whether it can be applied equally by non-clinicians and clinicians.

SUBMITTER: Lumenta DB

PROVIDER: S-EPMC6377131 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study.

Lumenta David Benjamin DB Sendlhofer Gerald G Pregartner Gudrun G Hart Marlies M Tiefenbacher Peter P Kamolz Lars Peter LP Brunner Gernot G

PloS one 20190215 2

<h4>Background</h4>Tumor boards (TB) play an important role to formulate a management plan for the treatment of patients with a malignancy. Recent evidence suggests that optimally functioning teams (teamwork, communication and decision making) are major prerequisites to conduct efficient TB meetings. The aims of this study were i) to use a readily published tool as a template for the development of a teamwork perspective extended assessment tool and ii) to evaluate the tool in a feasibility stud ...[more]

PMID: 30768645

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Project description:BackgroundThe quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation.MethodsAn adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis.ResultsN?=?249 cases were observed in N?=?29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation.ConclusionsThe quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints were found to play an important role. Some of those aspects seem modifiable, which offers possibilities for the reorganization of MDTMs.

Project description:BackgroundDiscussing 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.MethodsRelevant 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.ResultsSeventy-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.ConclusionsMDTMs 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.

Project description:BackgroundMultidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs.AimIdentify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC).Methods3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the "Calvados Registry of Digestive Tumours" were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival.ResultsNon-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1-2.0], p < 0.001).ConclusionsElderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.

Project description:BACKGROUND:Multidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research. This paper reports findings on how seven MDTs in cancer care utilized technological and information systems and the barriers and enabling factors that impacted on their uptake. METHODS:Seven multidisciplinary teams from two large metropolitan hospitals participated in the study. Qualitative methods including structured observations and semi structured interviews that explored how teams engaged in research and improvement activities were utilized. Participants were also observed and interviewed in relation to their use of data and health information systems. Findings were subject to content analysis and key themes were identified. Interviews were transcribed and de-identified and key themes were subsequently discussed with participants to allow for member checking and further clarification of findings. RESULTS:A total of 43 MDT meetings across seven tumor streams were observed. Of these, observation notes from 13 meetings contained direct references to emerging technologies and health information systems. Findings from 15 semi-structured interviews were also analyzed in relation to how MDTs used technology in weekly meetings, and the perceived impact of technology. Three broad themes emerged: (1) methods for data collection and use by MDTs, (2) the impact of technology on the MDT meeting environment, and (3) the impact of technology and information systems on clinical decision making. CONCLUSION:The study demonstrates that real time data collection and imaging may improve patient centered care coordination. However, ICTs can be used sub-optimally by teams. We therefore urge additional research to identify the enabling factors that support better collection and use of outcome data from ICT.

Dataset Information

Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study.

Publications

Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study.

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