Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study

Abstract

Background Tumor boards (TB) play an important role to formulate a management plan for the treatment of patients with a malignancy. Recent evidence suggests that optimally functioning teams (teamwork, communication and decision making) are major prerequisites to conduct efficient TB meetings. The aims of this study were i) to use a readily published tool as a template for the development of a teamwork perspective extended assessment tool and ii) to evaluate the tool in a feasibility study by clinical and non-clinical observers. Methods A systematic literature search in four databases revealed the “Metric for the Observation of Decision-making (MODe)” to be consistently used. MODe served as a template for the clinical evaluation, additional, notably teamwork items were integrated, and the resulting tool was tested in a feasibility study in TBs by clinical and non-clinical observers. The percentage of agreement between observers was assessed in a two-step approach: first, agreement of raters on discussion of items by TB members, and second, agreement of raters based on ordinal scale. Results In total, 244 patients were discussed in 27 TB sessions, thereof 136 (56%) fast track cases and 108 (44%) complex cases. In 228 (93%) of all cases an agreement for recommendation of a treatment plan was reached. Observers showed in general high agreement on discussion of the items. For the majority of items, the percentage of agreement between the different pairs of rater was similar and mostly high. Conclusion A newly developed TB team performance tool using MODe as a template was piloted in a German-speaking country and enabled the assessment of specialized multidisciplinary teams with a special focus on teamwork patterns. The developed assessment tool requires evaluation in a larger collective for validation, and additional assessment whether it can be applied equally by non-clinicians and clinicians.

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

“…They are open to other members, too ("non-core team"), such as palliative-care physicians, medical students, psychologists, physicians in training or nursing-staff specialists, research nurses, and coordinators. Some countries consider the role of nurse staff to be crucial in influencing treatment decisions and have decided to include nurses in the core team rather than the non-core team 1,8,13 (Figure 1).…”

Contributions to Multidisciplinary Team Meetings in Cancer Care: Predictors of Complete Case Information and Comprehensive Case Discussions

“…[12][13][14] Our observed mean scores for contributions to case presentations fit well with observations in MDTs for colorectal cancer and breast cancer with mean scores of 3.9-4.6 for patient history, 3.6-4.2 for radiology and 3.8-4.4 for pathology. 14,18,20 Also, the contributions to the case discussions with mean scores of 3.2-3.7 for chair, surgeon, oncologist, and radiologist with lower mean scores of 1.4-1.6 for pathologists and nurses are in line with observations from MDTs in colorectal cancer, breast cancer and ovarian cancer with mean scores of 4.7-4.8 for surgeons' contributions, 3.2-4.4 for radiologists, 4.5 for pathologists, 3.1 for oncologists and 4.1 for chairs. [19][20][21] Hence, case history, radiologic information and contributions from chairs, surgeons, radiologists, and oncologists seem to be key drivers of MDTs' decision-making.…”

“…[12][13][14] MTD-MODe has been applied in several countries and in various diagnostic settings, including breast cancer, lung cancer, gastrointestinal cancer, urological cancer and rare tumors to document elements of decision-making and define factors of importance for treatment recommendations. 11,[14][15][16][17][18][19][20][21][22] Chairing skills is one of the parameters evaluated in MODe, but the A Tumor Leadership Assessment (ATLAS) instrument has been developed to provide a more granular picture of MDT leadership aspects. 23 Though an increasing number of factors that affect team processes have been identified, heterogenous study designs, different data collection formats and variable clinical settings hamper definition of key performance indicators.…”

Development and validation of a short version of the Metric for the Observation of Decision-making in multidisciplinary tumor boards: MODe-Lite

“…4,[7][8][9] MODe has been used to assess decision-making processes across different tumour types in a number of different countries (Box 1). [7][8][9][10][11][12][13][14][15][16][17][18][19] MODe has been applied to show that the ability of an MTB to reach a clinical decision was positively associated with high-quality comprehensive and necessary information available at the point of decision-making (from case history, radiology, pathology), team contribution, 4,[9][10] and cases that are discussed at the beginning of meetings. [10][11] However, high-quality information and team contribution were positively correlated with the larger team size and longer case discussions.…”