Facilitators and barriers to conducting an efficient, competent and high-quality oncological multidisciplinary team meeting

Walraven, J.E.W.; Verhoeven, Rob; Meulen, R. van der; Hoeven, J.J.M. van der; Lemmens, Valery; Hesselink, Gijs; Desar, Ingrid M.E.

doi:10.1136/bmjoq-2022-002130

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…Key challenges to implementing HQI projects of multidisciplinary nature are clinician availability, adequate center capacity and resourcing, coordination of team efforts across multiple areas of expertise and need for strong team leadership. [38][39][40][41][42][43] Limited resourcing and capacity resulted in premature cancellation of the project in one center (Kelowna) and failure to implement the main HQI initiative in another (Vancouver). Merge of MDTs from two centers (Surrey and Abbottsford) was an adaptation mechanism used that is associated with increased capacity and reductions in overall and individual participant burden.…”

Section: Discussionmentioning

confidence: 99%

BeTTer Outcomes Workgroup Health Quality Initiative to optimize bone health for prostate cancer patients in the British Columbia Cancer System

Noonan,

Ko,

Black

et al. 2023

CUAJ

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Introduction: Bone-targeted therapies (BTTs) are integral to the management of bone metastases in metastatic castration-resistant prostate cancer (mCRPC). BTTs vary considerably in referral and drug access pathways and optimal BTT use requires multi-specialty consultation and supervision. Health quality improvement (HQI) has become the predominant framework to improve patient care in multidisciplinary settings. Methods: HQI initiatives on use of BTT in mCRPC were developed and evaluated in five centers of a provincial cancer center network using Plan-Do-Study-Act (PDSA) methodology. Multidisciplinary teams (MDTs) completed a common quality assessment form and an HQI template and then implemented an HQI initiative. Feedback and findings were shared and discussed at regional events. It was subsequently determined whether to adopt, adapt, or abandon initiatives. Results: Patterns of unmet needs varied across type of BTT. Gaps in use of radium-223 were mostly referral and education issues that could be directly addressed at the local level by participating clinician teams. Conversely, most supportive BTT gaps were related to coverage and resourcing support. HQI initiatives selected by each site consisted of implementation or expansion of local MDT meetings, referral documents, databases, and improvement charters. The main HQI initiative was completed in four sites and was adapted or adopted in three. Improvements in BTT use were observed in two of three centers with data on HQI process measures. Conclusions: Despite the overall heterogenous structure of the groups and metrics used, this study demonstrated that the PDSA framework provides the needed structure for improvements in BTT use in mCRPC across multiple sites.

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Section: Discussionmentioning

confidence: 99%

BeTTer Outcomes Workgroup Health Quality Initiative to optimize bone health for prostate cancer patients in the British Columbia Cancer System

Noonan,

Ko,

Black

et al. 2023

CUAJ

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“…Interviews had a median duration of 38.7 minutes and lasted between 27 and 72 minutes. It is worth noting that the interviews were also conducted to gain insight into the current perceived quality of MDTMs and whether they serve educational purposes for residents ( 29 , 39 ). These findings are beyond the scope of this article.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, time pressure forces MDTMs into a more business-like atmosphere, which harms team dynamics between participants ( 23 , 28 ). Previously, we reported facilitators and barriers on high quality and well-functioning MDTMs ( 29 ).…”

Section: Introductionmentioning

confidence: 95%

Pros and cons of streamlining and use of computerised clinical decision support systems to future-proof oncological multidisciplinary team meetings

Walraven

Verhoeven

Hoeven³

et al. 2023

Front. Oncol.

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IntroductionNowadays nearly every patient with cancer is discussed in a multidisciplinary team meeting (MDTM) to determine an optimal treatment plan. The growth in the number of patients to be discussed is unsustainable. Streamlining and use of computerised clinical decision support systems (CCDSSs) are two major ways to restructure MDTMs. Streamlining is the process of selecting the patients who need to be discussed and in which type of MDTM. Using CCDSSs, patient data is automatically loaded into the minutes and a guideline-based treatment proposal is generated. We aimed to identify the pros and cons of streamlining and CCDSSs.MethodsSemi-structured interviews were conducted with Dutch MDTM participants. With purposive sampling we maximised variation in participants’ characteristics. Interview data were thematically analysed.ResultsThirty-five interviews were analysed. All interviewees agreed on the need to change the current MDTM workflow. Streamlining suggestions were thematised based on standard and complex cases and the location of the MDTM (i.e. local, regional or nationwide). Interviewees suggested easing the pressure on MDTMs by discussing standard cases briefly, not at all, or outside the MDTM with only two to three specialists. Complex cases should be discussed in tumour-type-specific regional MDTMs and highly complex cases by regional/nationwide expert teams. Categorizing patients as standard or complex was found to be the greatest challenge of streamlining. CCDSSs were recognised as promising, although none of the interviewees had made use of them. The assumed advantage was their capacity to generate protocolised treatment proposals based on automatically uploaded patient data, to unify treatment proposals and to facilitate research. However, they were thought to limit the freedom to deviate from the treatment advice.ConclusionTo make oncological MDTMs sustainable, methods of streamlining should be developed and introduced. Physicians still have doubts about the value of CCDSSs.

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“…It is important to carefully consider these and design streamlining strategies that strike a balance between efficiency and comprehensive patient care ( 18 ). Engaging MDT members, maintaining open lines of communication, and regularly evaluating the impact of streamlining efforts can help address these disadvantages and optimize the benefits of streamlining in cancer MDT meetings ( 19 ).…”

Section: Challenges Barriers and The Role Of Implementation Sciencementioning

confidence: 99%

Implementation of streamlining measures in selecting and prioritising complex cases for the cancer multidisciplinary team meeting: a mini review of the recent developments

Al-Hammouri,

Almeida-Magana,

Soukup

et al. 2024

Front. Health Serv.

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In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.

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Facilitators and barriers to conducting an efficient, competent and high-quality oncological multidisciplinary team meeting

Cited by 5 publications

References 34 publications

BeTTer Outcomes Workgroup Health Quality Initiative to optimize bone health for prostate cancer patients in the British Columbia Cancer System

BeTTer Outcomes Workgroup Health Quality Initiative to optimize bone health for prostate cancer patients in the British Columbia Cancer System

Pros and cons of streamlining and use of computerised clinical decision support systems to future-proof oncological multidisciplinary team meetings

Implementation of streamlining measures in selecting and prioritising complex cases for the cancer multidisciplinary team meeting: a mini review of the recent developments

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