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Observational Study
. 2017 Nov 17;17(1):772.
doi: 10.1186/s12885-017-3768-5.

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study

Pola Hahlweg  1 , Sarah Didi  2 , Levente Kriston  2 , Martin Härter  2 , Yvonne Nestoriuc  3   4 , Isabelle Scholl  2
Affiliations
Observational Study

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study

Pola Hahlweg et al. BMC Cancer. .

Abstract

Background: The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation.

Methods: An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis.

Results: N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation.

Conclusions: The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints were found to play an important role. Some of those aspects seem modifiable, which offers possibilities for the reorganization of MDTMs.

Keywords: Cancer; Decision making; Multidisciplinary communication; Multidisciplinary team meeting; Observation; Oncology; Tumor board.

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Conflict of interest statement

Ethics approval and consent to participate

The study was carried out in accordance with the Code of Ethics of the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Association Hamburg (Germany) as part of the research project “Development of a program for routine implementation of shared decision-making in oncology” (reference number PV4309). Consent to participate was obtained from cooperating head physicians, and chairs of the observed MDTMs were informed about the study prior to data being collected. No individual patient data were collected within this study.

Consent for publication

Not applicable.

Competing interests

PH, SD, LK, and YN declare no conflicts of interest. MH declares that he is PI in a research project funded by Lilly Pharma and co-PI in a research project funded by Mundipharma, both pharmaceutical companies. IS conducted one physician training in shared-decision making within the research project funded by Mundipharma. The authors did not receive funding from Mundipharma or from Lilly Pharma for this paper, nor were the companies involved in any steps of the study or publication process.

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