Cancer multidisciplinary team meetings in practice: Results from a multi‐institutional quantitative survey and implications for policy change

Abstract

Aim: Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. Methods:We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics.Results: Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. Conclusions:MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making.With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence.

Electronic tumor board presentations as the basis for the development of a head and neck cancer database

“…Given the widespread adoption of different EMR systems in hospitals across the world, it is surprising that MDT presentations are often not embedded within this system but exist as separate files, often in free‐text form. Details of MDT discussions and decisions are recorded inconsistently, and salient discussion points may be missing . The lack of important details can be an issue during recall, or worse, if there were a medicolegal enquiry on the case.…”

“…Details of MDT discussions and decisions are recorded inconsistently, and salient discussion points may be missing. 19 The lack of important details can be an issue during recall, or worse, if there were a medicolegal enquiry on the case. Apart from the primary clinician in charge, the concerned MDT members who participated in the discussion and treatment decisions can be potentially culpable.…”

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.…”

“…None of these studies reported on data feedback to the MDT although two performed analyses on data collected by the MDT or the local clinical cancer registry. Rankin et al surveyed 37 Australian MDTs across a range of tumor streams on MDT purpose, processes, caseload, and quality assurance and identified the potential lack of access to databases for key information on patient population. A mixed‐methods study of a lung cancer MDT‐reporting template for general practitioners identified a data set that general practitioners found easy to interpret and communicate to their patients.…”

“…A recent review of MDT resources and practice identified the importance of data collection to effective MDT practice, as well as barriers to successful collection . A recent multisite MDT survey that investigated practical aspects of team meetings identified a lack of timely access to data and irregular conduct of audits to inform practice . It should also be noted that the proportion of new lung cancer cases discussed at MDT has been reportedly low, below 30% in some series …”