Team Dynamics, Decision Making, and Attitudes Toward Multidisciplinary Cancer Meetings: Health Professionals' Perspectives

Abstract

Purpose: Multidisciplinary cancer care is a standard feature of high quality care. In many centers, the multidisciplinary meeting (MDM) is an integral component. A qualitative study was performed to explore health professionals' attitudes towards this model of care, the decision making processes, and dynamics among team members.Methods: A series of focus groups was conducted with health professionals who attend MDMs at our institution. Focus groups followed a semistructured format with open-ended questions. A thematic analysis was performed.Results: Four focus groups were held, attended by 23 participants including allied health professionals, specialist nurses, medical oncologists, and surgeons. All participants believed the primary objective of the MDM was to develop an individualized treatment plan. Several other key themes emerged. The MDM provided opportunities to improve communication, efficiency, and education as well as enhance professional relationships. Medical information was prioritized ahead of psychosocial details, with allied health professionals describing difficulty contributing to MDM discussion. Patient attendance at MDMs was opposed by health professionals because of concerns about the patient's ability to cope with the information discussed and the effect their presence would have on the dynamics of the decision-making process. Conclusion: Health professionals endorse MDMs as a usefultool in treating patients with cancer. Within this forum, both opportunities and constrains exist, with many benefits extending beyond the meeting itself into other clinical areas. Further study is warranted to establish an evidence base to ensure that both the possibilities and the limitations of this model of care are fully understood.

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“…However, the wider 'social networks' of each of these key stakeholders may also be involved in the DM process and influential over the final decision, including other patients, family members, health professionals, friends, and neighbours [17,40]. In addition, a growing body of evidence is recognising that clinicians also exist within interprofessional networks, and other clinicians, allied health team members, and healthcare administrators may inform the clinician's position within the DM process [41][42][43]. Indeed, the involvement of other health professionals is well documented in situations where complex medical decisions are discussed at multidisciplinary team meetings [e.g.…”

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“…However, despite the obstacles facing MDTs, several important patient benefits have been reported, including greater accuracy of disease staging [135], fewer treatment and referral delays [136,137], individualized evidence-based practice for patients, greater continuity of care [138], enhanced quality of life [139], and better clinical and survival outcomes [140 -146]. In addition, health care professionals and health services may benefit from MDTs through strengthened awareness, communication, and relationships among members and disciplines, increasing the opportunities for knowledge sharing and professional development (e.g., review sessions providing learning opportunities for staff) [136,147,148]. Other advantages include facilitation of clinical trial recruitment [149], minimization of duplication of effort, opportunities to pool resources and encourage crosstraining [150], and the potential to alleviate regional disparities in health care services.…”

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“…Yet, recent evidence from a Scottish study has linked substantially greater improvement in breast cancer survival to MDC, over and above improvement expected to occur in the absence of MDC [12]. Discussions of individual cases at the MDT meetings provide an excellent opportunity for training physicians and nurses [13]. Also, team meetings assist in communication and information sharing between members, particularly between hospital-based specialists and primary care providers, which enhance referral and continuing care pathways [14].…”

“…As indicated above, nurses play a crucial role in coordinating care, as well as in representing the patient's views and psychological aspects of care, especially as psychological concerns are often neglected in favor of medical information [13].…”