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Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP).

ABSTRACT: INTRODUCTION:Although colorectal cancer outcomes in England are improving, they remain poorer than many comparable countries. Yorkshire Cancer Research has, therefore, established a Bowel Cancer Improvement Programme (YCR BCIP) to improve colorectal cancer outcomes within Yorkshire and Humber, a region representative of the nation. It aims to do this by quantifying variation in practice, engaging with the colorectal multidisciplinary teams (MDTs) to understand this and developing educational interventions to minimise it and improve outcomes. METHODS AND ANALYSIS:Initially, routine health datasets will be used to quantify variation in the demographics, management and outcomes of patients across the Yorkshire and Humber region and results presented to MDTs. The YCR BCIP is seeking to supplement these existing data with patient-reported health-related quality of life information (patient-reported outcome measures, PROMs) and tissue sample analysis. Specialty groups (surgery, radiology, pathology, clinical oncology, medical oncology, clinical nurse specialists and anaesthetics) have been established to provide oversight and direction for their clinical area within the programme, to review data and analysis and to develop appropriate educational initiatives. ETHICS AND DISSEMINATION:The YCR BCIP is aiming to address the variation in practice to significantly improve colorectal cancer outcomes across the Yorkshire and Humber region. PROMs and tissue sample collection and analysis will help to capture the information required to fully assess care in the region. Engagement of the region's MDTs with their data will lead to a range of educational initiatives, studies and clinical audits that aim to optimise practice across the region.

SUBMITTER: Taylor J

PROVIDER: S-EPMC6886907 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP).

Taylor John J Wright Penny P Rossington Hannah H Mara Jackie J Glover Amy A West Nick N Morris Eva E Quirke Phillip P

BMJ open 20191126 11

<h4>Introduction</h4>Although colorectal cancer outcomes in England are improving, they remain poorer than many comparable countries. Yorkshire Cancer Research has, therefore, established a Bowel Cancer Improvement Programme (YCR BCIP) to improve colorectal cancer outcomes within Yorkshire and Humber, a region representative of the nation. It aims to do this by quantifying variation in practice, engaging with the colorectal multidisciplinary teams (MDTs) to understand this and developing educati ...[more]

PMID: 31772088

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Project description:Background and study aims Bowel cancer affects 3,300 people a year within Yorkshire and the Humber. Over the next five years over 6,000 people in Yorkshire and the Humber will die of bowel cancer. This study wants to greatly reduce this number, decrease the number of deaths and improve the patients’ experience of their care. The management of bowel cancer and outcomes for patients across Yorkshire and the Humber differs. This study wants to understand why there is a difference and then improve outcomes by addressing these issues. The study will use data collected during the diagnosis and treatment of patients with bowel cancer in the NHS. This data has been linked together by the National Cancer Registration and Analysis Service (NCRAS) and provides basic information about bowel cancer care across the region. This study will improve this information by consenting patients and collecting new data via patient reported outcome measures (PROMS) and will also collect additional data from radiology and pathology to improve the data that is held. The study team will analyse this data to find areas that can be improved and work with the clinical teams to provide educational events and improvements. The study team will assess the differences made to the care and outcome of bowel cancer patients across the region. The overall aim of this programme of work is to work out how much bowel cancer outcomes can be improved by working with bowel cancer multidisciplinary teams (MDTs), collecting and feeding back to them high quality information and providing training and supervision for specialists where a need is found. The primary aims of the study are: 1. To develop high quality cancer information to evaluate the outcomes for patients with bowel cancer across Yorkshire and the Humber 2. To describe the quality of life of newly diagnosed bowel cancer patients close to the time of diagnosis. This will provide a starting point to measure differences in quality of life across Yorkshire and Humber. 3. To explore the issues that may be able to predict the quality of life of patients 12 months after diagnosis. 4. To collect tissue for testing to show whether certain chemotherapy drugs can be used to improve outcomes. 5. To support the introduction of NICE recommended Lynch testing in the region. Lynch Syndrome is an inherited disorder that increases the risk of many types of cancer, particularly bowel cancer. Who can participate? Patients over the age of 18 with bowel cancer who live in the Yorkshire and Humber region of the UK and who are treated at one of the 14 participating hospital trusts What does the study involve? The study involves asking patients to agree to complete two questionnaires; one shortly after diagnosis but before they have had their first treatment, and the second questionnaire 12 months after their diagnosis. These questionnaires can be completed online or on paper. The study also asks for agreement for some of the tissue that has been removed during the patient’s surgery for bowel cancer to be sent to the University of Leeds study teams so that additional tests can be performed on the tissue.

Project description:ObjectiveThe objective of this study was to examine effectiveness of codesigned quality-improving interventions with a multidisciplinary team (MDT) with high workload and prolonged meetings to ascertain: (1) presence and impact of decision-making (DM) fatigue on team performance in the weekly MDT meeting and (2) impact of a short meeting break as a countermeasure of DM fatigue.Design and interventionsThis is a longitudinal multiphase study with a codesigned intervention bundle assessed within team audit and feedback cycles. The interventions comprised short meeting breaks, as well as change of room layout and appointing a meeting chair.Setting and participantsA breast cancer MDT with 15 members was recruited between 2013 and 2015 from a teaching hospital of the London (UK) metropolitan area.MeasuresA validated observational tool (Metric for the Observation of Decision-making) was used by trained raters to assess quality of DM during 1335 patient reviews. The tool scores quality of information and team contributions to reviews by individual disciplines (Likert-based scores), which represent our two primary outcome measures.ResultsData were analysed using multivariate analysis of variance. DM fatigue was present in the MDT meetings: quality of information (M=16.36?to M=15.10) and contribution scores (M=27.67?to M=21.52) declined from first to second half of meetings at baseline. Of the improvement bundle, we found breaks reduced the effect of fatigue: following introduction of breaks (but not other interventions) information quality remained stable between first and second half of meetings (M=16.00?to M=15.94), and contributions to team DM improved overall (M=17.66?to M=19.85).ConclusionQuality of cancer team DM is affected by fatigue due to sequential case review over often prolonged periods of time. This detrimental effect can be reversed by introducing a break in the middle of the meeting. The study offers a methodology based on 'team audit and feedback' principle for codesigning interventions to improve teamwork in cancer care.

Dataset Information

Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP).

Publications

Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP).

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