The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study

Abstract

Purpose: There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. Methods: This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. Results: Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. Conclusions: CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings.

Exploring non-physician care professionals’ roles in cancer multidisciplinary team meetings: A qualitative study

“…); 2) another group, composed mainly of experienced nurses and specialist nurses, perceive their role in MDTMs as active, as for the exchange of patients’ non-medical information in MDTMs. However, despite the alternative views of the second group, overall our results show that non-physician care professionals play a limited role during case discussions in MDTMs, a finding that is in line with recent literature on a nurse’s role in multidisciplinary team meetings [ 26 , 36 – 39 ]. Neither do they actively participate in the decision-making process.…”

“…To overcome this lack of non-medical, patient-based information, it might be recommended that designated team members act as patients’ advocates during the team meetings [ 19 ]. Literature refers repeatedly to (specialist) nurses or other non-physician care professionals such as psychologists who can adopt this role [ 24 – 26 ]. Besides the clinical skills which are unique to their discipline and their own clinical wisdom and knowledge that might enhance a true holistic approach for the MDTMs, they are also more likely to hold particular patient centred information.…”

Multidisciplinary decision-making in older patients with cancer, does it differ from younger patients?

“…Nurses often possess useful, patientcentered, information which makes them ideal as case managers. Providing them with a substantial role in MDTs, in order to share this information, might enhance tailored decision-making [33,34]. Unfortunately, the input of nurses in the observed MDTs was also almost nonexistent as was the input of patient-centered information, such as patient preferences and psychosocial information.…”

Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review

“…A large survey including 1636 MDT members recommended a crucial role for the CNS in representing patient preferences [56]. A more prominent role for the CNS has also been suggested by others [75,88]. In an observational study of 171 elderly patients with colorectal cancer a suboptimal decision-making process was observed due to limited use of patient-centered information, such as age-related patient characteristics and preferences [21].…”

“…They also described 13 facilitators of clinical decision making, including adequate knowledge of guidelines and recent evidence, standardisation of decision making and facilitation of collegiality and teamworking [31]. An observational study noted five ways in which the clinical nurse specialist (CNS) positively contributed to the decision-making process: sharing information, asking questions, providing practical suggestions, framing and using humour [88].…”