Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework

Abstract

BackgroundEvidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.Objectives(1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).MethodsSemistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.ResultsIn total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).ConclusionsThe internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.

Orthopaedic physiotherapists’ perceptions of mechanisms for observed variation in the implementation of physiotherapy practices in the early postoperative phase after hip fracture: a UK qualitative study

“…However, nurses reported a need for physiotherapists to manage expectations of other team members through greater understanding of the demands and pressures of their practice [ 32 ]. This collective action may be achieved through greater team communication and engagement in clinical governance meetings, which are currently underprioritized due to staff time and/or reduced confidence to participate in discussions [ 7 , 33 ].…”

How do patients make decisions in the context of a multidisciplinary team: an ethnographic study of four head and neck cancer centres in the north of England

“…National Health Service patients rarely attend their MDT meetings, modern cancer care mandates that all patients are discussed in this setting 26 and interventions to increase the number of patients discussed in an MDT are still sought after. 27 The MDT recommendation If the MDT meeting and clinic follow a paternalistic pathway, the way in which their recommendation is used is clear: it is delivered to the patient with an assumption that it will be accepted. In the paternalistic tradition, physicians are considered to be best placed to evaluate the trade-offs and pitfalls of treatment, and applied these to the decision process based on their evaluation of the best interests of the patient.…”

Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians

“…The BCW54 55 is a ‘theory and evidence based’ intervention development approach58 that provides guidance on considering and identifying the function of interventions (eg, education, persuasion, enablement) and policy categories that may support the delivery of these functions (eg, guidelines, service provision, environmental planning) and how these both link to MoAs and/or BCTs. The TDF and related resources have been used to inform the development and evaluation of health-focused behavioural interventions,59–61 including informing the data collection and/or analysis of qualitative studies forming an early stage in the process of intervention development 62–65…”

“…The TDF and related resources have been used to inform the development and evaluation of health-focused behavioural interventions, [59][60][61] including informing the data collection and/or analysis of qualitative studies forming an early stage in the process of intervention development. [62][63][64][65] Data collection: interview content and procedures Participants will take part in one semistructured qualitative interview lasting around 45 min, though duration is likely to be variable depending on how much a participant wishes to say and their preferred interview pace.…”