Patients’ Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings

Abstract

BackgroundThe contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions.DesignObservations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed.ResultsIn the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available.LimitationsThe design of the study made it difficult to draw definite cause-and-effect conclusions.ConclusionThe Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians’ everyday professional practice. The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

Determinants of variable resource use for multidisciplinary team meetings in cancer care

“…The number of case discussions, mean 12.6 (range 2-36), the length of the meetings, mean 0.88 h, and the time per case discussion, mean 4.2 min. were also comparable to observations from UK with 14-35 case discussions, MDTM lengths of 1-2.5 h and case discussions of 4-7 min [13,14]. MDTM length naturally correlates with the number of case discussions, but also other factors such as cancer type, hospital type, use of video facilities influence MDTM length (Figure 1).…”

“…In cancer care, MDTMs represent an important possibility for case review and expert opinion. Based on observations and time estimates from cancer-related MDTM in Swedish health care we demonstrate that mean 8.2 physicians and 2.9 nurses-coordinators participate in the MDTMs, which is in line with data from UK on 6-10 participating physicians [13]. The number of case discussions, mean 12.6 (range 2-36), the length of the meetings, mean 0.88 h, and the time per case discussion, mean 4.2 min.…”

Benefits, barriers and opinions on multidisciplinary team meetings: a survey in Swedish cancer care

“…Though many MDTM groups struggle with how to best include patient-related perspective in the decision process, a limited focus on these aspects have been documented in several studies [ 21 ]. Restivo et al found that psychological, socio-demographic and relational aspects were discussed in 30% of the cases and patient’ preferences were discussed in 10% of the cases at MDTMs in French health care [ 22 ]. Divergent treatment priorities between physicians and patients have been demonstrated in multiple studies and cancer types.…”

“…MDTM leaders often express a clear view on the optimal treatment recommendation. Team members may counteract this by providing additional patient-related information, which may influence the further discussion, though perhaps based on fragmented and selected information [ 22 ]. Additionally, when the information is conveyed to the patient, it needs to be balanced, which requires that controversies and differences in opinion have been clarified.…”

Knowing what the patient wants: a hospital ethnography studying physician culture in shared decision making in the Netherlands

“…33 Another observational study of tumour board meetings showed that patient characteristics were mentioned more frequently during those meetings where more time was spent discussing an individual patient. 32 The current study setup is not designed to show such causalities. In the light of these previous study results, however, it is plausible that the way patient workup was organised might be limiting the proper use of SDM principles.…”