Exploring non-physician care professionals’ roles in cancer multidisciplinary team meetings: A qualitative study

Horlait, Melissa; Regge, Melissa De; Baes, Saskia; Eeckloo, Kristof; Leys, Mark

doi:10.1371/journal.pone.0263611

Cited by 13 publications

(14 citation statements)

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“…Nevertheless, some evidence shows that the inclusion of nursing personnel is viewed as less important [ 14 , 35 – 37 ]. Indeed, several authors have shown that the biomedical approach tends to take precedence over other points of view [ 15 , 35 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary team meetings in Hematology: a national mixed-methods study

Polomeni,

Bordessoule,

Malak

2023

BMC Cancer

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Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants’ perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients’ wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary team meetings in Hematology: a national mixed-methods study

Polomeni,

Bordessoule,

Malak

2023

BMC Cancer

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“…Numerous calls have been made to include more patient-centred information during MDTs [13][14][15]. The 2014 European policy statement on cancer MDTs emphasized that patients' treatment and care preferences should be discussed before making decisions [16].…”

Section: Why In Clude Non -Medic Al Patient Information and Patient V...mentioning

confidence: 99%

“…At the same time, their viewpoints and information are often given little weight in MDT decisions [30,31]. Nonphysicians and nurses also perceive that their information is not being heeded or adding to the decisions that are made [13,29,32]. Shifting the team dynamics to ensure that all patient information is presented, shifting roles as to who presents the information and/or changing mindsets about the value of bringing the patient perspective into MDT decisions could help to increase the likelihood that patient information is attended to in the recommendation.…”

Section: How S Hould Patient Information B E In Corp or Ated?mentioning

confidence: 99%

“…Power distance between patients and doctors, lack of information or misperceptions about the implications of declining a recommendation can result in patients going along with a recommendation. Numerous calls have been made to include more patient‐centred information during MDTs [13–15]. The 2014 European policy statement on cancer MDTs emphasized that patients' treatment and care preferences should be discussed before making decisions [16].…”

Section: Why Include Non‐medical Patient Information and Patient View...mentioning

confidence: 99%

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Multidisciplinary teams and social science: a patient perspective

Ostroff

2024

Colorectal Disease

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Multidisciplinary teams (MDTs) are common in colorectal cancer and have been deemed important when providing care. Yet they take place outside of the patient, often with little consideration of the patient's views, goals and desires. In this paper specific examples from a patient perspective are integrated with the social science literature to provide an overview of areas of disconnect between MDT recommendations and the individual patient. The reasons for these disconnects are explored, including how MDTs relate to dyadic patient–clinician relationships, weak incorporation of patient‐oriented outcomes in MDTs, poor integration of nonmedical patient information and the patient perspective and the impact of team dynamics and cognitive decision biases. Consideration of these issues should facilitate higher‐quality MDT recommendations that are also more acceptable to patients.

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“…MDT meetings are often dominated by discussion among doctors rather than including other MDT members who may know the patient better or have a more patientcentred perspective, [11][12][13][14] creating a predominance of the biomedical model of disease. [15][16][17] This means that the stated aim of many MDT members-to have the patient central to the MDT treatment discussion-is at odds with the reality of the MDT process.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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

et al. 2022

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ObjectivesTo describe how patients are engaged with cancer decisions in the context of multidisciplinary team (MDT) and how MDT recommendations are operationalised in the context of a shared decision.DesignEthnographic qualitative study.SettingFour head and neck cancer centres in the north of England.ParticipantsPatients with a diagnosis of new or recurrent head and neck cancer; non-participant observation of 35 MDT meetings and 37 MDT clinics, informal interviews, and formal, semistructured interviews with 20 patients and 9 MDT staff members.MethodsEthnographic methods including non-participant observation of MDT meetings and clinic appointments, informal interviews, field notes and formal semistructured interviews with patients and MDT members.ResultsMDT discussions often conclude with a firm recommendation for treatment. When delivered to a patient in clinic, this recommendation is often accepted by the patient, but this response may result from the disempowered position in which they find themselves. While patient behaviour may thus appear to endorse clinicians’ views that a paternalistic approach is desired by patients (creating a ‘cycle of paternalism’), the rigidity of the MDT treatment recommendation can act as a barrier to discussion of options and the exploration of patient values.ConclusionsThe current model of MDT decision-making does not support shared decision-making and may actively undermine it. A model should be developed whereby the individual patient perspective has more input into MDT discussions, and where decisions are made on potential treatment options rather than providing a single recommendation for discussion with the patient. Deeper consideration should be given to how the MDT incorporates the patient perspective and/or delivers its discussion of options to the patient. In order to achieve these objectives, a new model of MDT working is required.

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Exploring non-physician care professionals’ roles in cancer multidisciplinary team meetings: A qualitative study

Cited by 13 publications

References 50 publications

Multidisciplinary team meetings in Hematology: a national mixed-methods study

Multidisciplinary team meetings in Hematology: a national mixed-methods study

Multidisciplinary teams and social science: a patient perspective

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

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