Medical decision making for older patients during multidisciplinary oncology team meetings

Abstract

Objectives: Multidisciplinary team meetings aim to facilitate efficient and accurate communication surrounding the complex process of treatment decision making for older patients with cancer. This process is even more complicated for older (≥70 years) patients as the lack of empirical evidence on treatment regimens in patients with age-related problems such as comorbidity and polypharmacy, necessitates a patient-centred approach.This study investigates the decision making process for older patients with cancer during multidisciplinary team meetings and the extent to which geriatric evaluation and geriatric expertise contribute to this process.

Methods: Non-participant observations of 171 cases (≥70 years) during 30 multidisciplinary team meetings in five hospitals and systematically analysed using a medical decision making framework. All cases were in patients with colon or rectal cancer.

Results: First, not all steps from the medical decision making framework were followed. Second, we found limited use of patient-centred information such as (age-related) patient characteristics and patient preferences during the decision making process. Third, a geriatric perspective was largely missing in multidisciplinary team meetings.

Conclusions: This study uncovers gaps in the treatment decision making process for older patients with cancer during multidisciplinary team meetings. In particular individual vulnerabilities and patient wishes are often neglected.

Keywords: Aged; Clinical decision-making; Colorectal cancer; Geriatric assessment; Interdisciplinary communication; Multidisciplinary oncology team meeting; Patient-Centred care.