Availability and feasibility of structured, routine collection of comorbidity data in a colorectal cancer multi-disciplinary team (MDT) setting

Abstract

PurposeAvailability of comorbidity assessment at multi-disciplinary team (MDT) discussions is cornerstone in making the MDT process more robust and decisive in optimising treatment and improving quality of survivorship. Comorbidity assessments using tools, such as the ACE-27 questionnaire would aid in optimising the decision-making process at MDTs so that treatment decisions can be made without delay. This study determined the availability of comorbidity data in a CRC MDT and the feasibility of routine comorbidity data collection using the validated ACE-27 questionnaire. Secondary aims determined the optimal time and method of collecting comorbidity data.MethodsA retrospective mapping exercise (phase I; 6-months) examined the availability of comorbidity data within the MDT. Phase II prospectively collected comorbidity data using ACE-27 for a 3-month period following a short pilot.ResultsIn phase I, 73/135 (54%) patients had comorbidity data readily available informing the MDT discussion; 62 patients lacked this information. After a review of the patient records, it was clear that 41 of these 62 also had comorbidities and 21 out of the 135 had ≥ 2 major system disorders. Common referral sources to the MDT were surgical outpatient clinics (42%) and the endoscopy unit (13%). The average lead-time from referral to MDT discussion was 14 days. In phase II, an ACE-27 questionnaire was prospectively administered in 50 patients, mean age 54 years (range 20–84). Male: female ratio 26:24. Average time to administer ACE-27 was 4.8 min (range 1–15).ConclusionsThe phase I study confirmed the widely acknowledged view of poor comorbidity data availability within a CRC MDT. Phase II demonstrated the feasibility of routinely collecting comorbidity data using ACE-27.

Medical and Nonmedical Information during Multidisciplinary Team Meetings in Cancer Care

“…A comprehensive case presentation requires a structured and condensed provision of relevant medical information on the diagnostic path, including information on symptoms, biomarker measures, imaging results, pathology, tumor stage and definition of treatment-related considerations. Presentation of patient characteristics should efficiently capture the essence of risk factors, performance status, information on relevant comorbidities and available information on patient preferences [ 19 , 20 , 21 ]. Though many MDT teams have performed targeted quality improvement work related to, e.g., referral guidelines, meeting structure and case discussion format, there is a lack of guidelines on which data elements should be provided for a comprehensive MDT case discussion.…”

Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study

“…To our knowledge, no studies have evaluated and reported the responses of lung cancer MDT members to data presentation and feedback using a mixed‐methods approach. Several studies investigate aspects of MDT practice (from lung cancer and other streams), including processes, reporting to general practitioners, data characteristics, and timing of MDT discussion . The systematic review by Prades et al includes three papers that focus on aspects of lung cancer MDT care.…”

“…From studies involving other tumor streams, a UK study of comorbidity data collection by a single‐center colorectal cancer MDT showed a marked improvement with the introduction of routine ACE‐27 index calculation in surgical clinics prior to the MDT (increasing from 54% to 100% comorbidity data availability post‐intervention). A UK observational study of serial breast cancer MDT meetings in a single center identified higher quality biomedical information (history, radiology, and pathology) compared with patient‐related information (psychosocial, comorbidities, and patient views) as scored by the previously published MDT‐MODe assessment tool .…”

“…A recent systematic review of studies addressing the organization of MDTs identified data issues, including quality of facilities, online and computing needs, and administrative support . Other MDT data‐related topics investigated in a range of tumor streams include gaps in comorbidity data, standardized reporting to general practitioners, possible deficiencies in collection of patient‐related factors, and optimal timing of MDT presentation …”

Human factors awareness and recognition during multidisciplinary team meetings

“…It is evident that some data (such as comorbidity) are not being recorded consistently by MDTs across the medical and surgical specialties . Use of a checklist and ground rules made clear before every MDT and perhaps circulated via email or on the previous MDT list might improve this process.…”