A pilot study to evaluate the impact of involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

“…It is worth highlighting the amount of attention paid to maintaining consistent communication and delivery of information between the team and the patient. Explanations for this included the need to improve management of therapy-induced adverse effects and, in a broad sense, quality-of-life aspects, both of which call for patients and families to play an active role [16,22,33,48,53,54].…”

“…Although several papers reflected that MDTs worked in accordance with a regional or national policy strategy [20][21][22]26,29,31,34,41,[44][45][46][47][48][49][50][51][52] (with some exceptions [16,69,70]), teamwork was rarely framed by specific policy guidance. Its absence led to some problems, for instance, emotional exhaustion among team leaders and clinical nurses owing to the lack of defined professional roles and team training [43,63].…”

“…Essentially, there were three types of formats in clinical practice. Firstly, there were meetings, which lasted anywhere from 30 min to 2 h and included either all or a selection of diagnosed and/or referred patients; patients were selected by the specialist in charge based on the case's level of complexity or the wide range of therapeutic possibilities, prearranged team criteria, or triage by the clinical coordinator [27,30,[32][33][34]46,48,50]. A second MDT format was the multidisciplinary clinic, where patients were not only seen but also simultaneously examined [16,38,40,53,54] or remotely coordinated by all board members [42].…”

“…The different scopes of coordination and the need to adapt to particular practice contexts implied the problem of finding 'equivalents' of the role and defining consistent profiles. Nonetheless, an analysis of the studies allowed the differentiation between 'inward' responsibilities (MDT organisation and efficient direction) and Harrison [45] Lanceley [46] Soukop [47] Choy [48] Chirgwin [49] Scher [ Wilcoxon [52] Magnani [53] Hudak [54] Wiederholt [55] Maslin-Prothero [56] Kuroki [57] Sweeney [58] Brennan [60] Jefford [61] Hong [62] Jones [63] Bellardita [64] Mandate adapted from Wright et al [12] 'outward' responsibilities (clinical management of the care plan). Whereas inward responsibilities consisted of scheduling agendas for meetings, drawing up the list of patients to be discussed, ensuring that all necessary tests were obtained and available in advance of the discussion, and recording the MDT decisions and rationales agreed [34,38,42,45,46], outward tasks entailed communicating decisions to patients/families, GPs, providers and referring physicians, as well as coordinating outpatient visits and referrals from satellite centres, and facilitating the link to research either directly or by improving liaison with the clinical trial coordinator [24,32,34,38,42,43,53,54].…”

“…A number of papers identified the need to take into account patients' physical and psychological comorbidities when making clinical decisions; furthermore, they noted that special attention should be paid to provide the same clinical message and bridging gaps between teams and patients, as well as clearly setting out how to deal with the complexities of the health care system [43,44,53,54,56,60,63]. Other studies addressed issues such as the patient-doctor relationship within a multidisciplinary setting, the impact of pre-existing knowledge of the patient in MDT discussions, patient attendance at and involvement in MDT meetings, and the way in which the patients are approached to participate in clinical trials [46,48,56,64]. The need to facilitate access to community resources, namely, patient support groups, libraries and volunteers, was also described [54,55,58].…”