Improving Decision Making in Multidisciplinary Tumor Boards: Prospective Longitudinal Evaluation of a Multicomponent Intervention for 1,421 Patients

Lamb, Bernard Charles; Green, James S. A.; Benn, Jonathan; Brown, Katrina; Vincent, Charles; Sevdalis, Nick

doi:10.1016/j.jamcollsurg.2013.04.035

Cited by 123 publications

(166 citation statements)

References 24 publications

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“…The process of tool development and validation has been reported in detail [7,[16][17][19][20][21]. MTB-MODe allows an evaluator to rate the following elements on five-point behaviorally anchored scales:…”

Section: Methodsmentioning

confidence: 99%

“…The participating MTBs had previously been recruited to participate in separate research projects [e.g. [16][17][18]. At the time of data collection ethical approvals were in place for all hospitals/teams, and informed consent was obtained verbally from all MTB members (REC reference for urology MTB is 10/H0805/32; at lung, colorectal and breast MTBs the study was reviewed and approved as clinical service evaluation).…”

Section: Participants and Settingmentioning

confidence: 99%

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Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study

et al. 2016

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SynopsisInput into multidisciplinary tumor boards (MTB) by all core disciplines is crucial for making treatment recommendations. Patients' psychosocial information stimulates decision-making, and must be considered by MTBs, while comorbidities, or those requiring nursing input suggest complexity, and decision-making is impaired. 3 AbstractBackground. In many healthcare systems, treatment recommendations for cancer patients are

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Section: Methodsmentioning

confidence: 99%

Section: Participants and Settingmentioning

confidence: 99%

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study

et al. 2016

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“…On the whole, it can be assumed based on the known high clinical influence of radiological case conferences on the further diagnostic and therapeutic cascade that the end points achieved in our study (change in treatment concept, additionally ordered examination) are representative. This is the case in particular in difficult cases at a tertiary care center [1].…”

Section: Discussionmentioning

confidence: 95%

“…In contrast to tumor boards, radiological case presentations in clinical case conferences include only two clinical partners, namely the presenting radiologist and the treating managing physician. Tumor boards, on the other hand, are multidisciplinary and are often limited, due to the specialization of the participants, to individual organ regions or specific clinical issues [1].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine

Dendl

Teufel

Schleder

et al. 2017

Fortschr Röntgenstr

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ABSTR ACTPurpose Evaluation of clinical impact regarding diagnostic and therapeutic changes influenced by interdisciplinary radiological case presentations. Materials and MethodsProspective evaluation of radiological-gastrointestinal clinical case conferences over a 1-year period at a tertiary care center. We documented the preparation (phase 1) and clinical case conference (phase 2) regarding their impact on the radiology report and further diagnostic work-up and therapy.Results 1067 examinations were evaluated in 69 clinical case conferences including 487 cases. We calculated a mean time of 35.8 minutes per conference with 5.1 minutes per case for preparation. During phase 1, major changes compared to the previous report were found in 1.2 % of cases, and no change was found in 91.4 % of cases. In phase 2 an additional relevant finding was found in 0.6 % of cases, while there was no major change to the reports in 99 % of cases. We recommended further radiological diagnostic workup in 9 % of cases and interventional radiological examination in 2.7 % of cases, while no change was documented in 83.2 %. Further radiological or surgical therapy was recommended in 7 % and 6.8 % of cases, respectively. There was no change in therapy in 78.5 % of cases. ConclusionThe analysis of an interdisciplinary radiological case presentation in internal medicine shows that the case discussion with the radiologist results in a change in patient management in 37.3 % of cases (16.8 % diagnosis, 21.5 % therapy). Overall, interdisciplinary ra-

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“…This might involve supporting the restriction of 'gate-keeping' decisions to a small number of people, with more decisions being made collectively in smaller expert groups. This has been indicated as effective in domains such as cancer care (Lamb et al 2013), although groups can also show practice variations in terms making risk-related decisions (Isenberg 1986). In addition, formalising training for specific risk trade-offs into educational programmes would help to bring consistency in decision-making, for example through providing insight on the how such complex decisions might be made, and through…”

Section: Practical Implicationsmentioning

confidence: 99%

Impossible decision? An investigation of risk trade-offs in the intensive care unit

2017

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b centre for Perioperative medicine and critical care research, imperial college Healthcare nHs Trust, London, UK ABSTRACTIn the intensive care unit (ICU), clinicians must often make risk trade-offs on patient care. For example, on deciding whether to discharge a patient before they have fully recovered in order to create a bed for another, sicker, patient. When misjudged, these decisions can negatively influence patient outcomes: yet it can be difficult, if not impossible, for clinicians to evaluate with certainty the safest course of action. Using a vignette-based interview methodology, a naturalistic decision-making approach was utilised to study this phenomena. The decision preferences of ICU clinicians (n = 24) for two common risk trade-off scenarios were investigated. Qualitative analysis revealed the sample of clinicians to reach different, and sometimes oppositional, decision preferences. These practice variations emerged from differing analyses of risk, how decisions were 'framed' (e.g. philosophies on care), past experiences, and perceptions of group and organisational norms. Implications for patient safety and clinical decision-making are discussed.Practitioner Summary: Physicians managing ICUs have to make rapid decisions with incomplete information and suboptimal resources. A qualitative vignette-based interview study examined how such decisions are made. We found physicians used a heterogeneous mixture of risk assessments, factual knowledge and prior experience to make judgements, which leads to potential for inconsistent decision-making.

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Improving Decision Making in Multidisciplinary Tumor Boards: Prospective Longitudinal Evaluation of a Multicomponent Intervention for 1,421 Patients

Cited by 123 publications

References 24 publications

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study

Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine

Impossible decision? An investigation of risk trade-offs in the intensive care unit

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