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Observational Study
. 2019 Feb;43(2):559-566.
doi: 10.1007/s00268-018-4815-3.

Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making

T A K Gandamihardja  1 , T Soukup  2 , S McInerney  3 , J S A Green  4 , N Sevdalis  2
Affiliations
Observational Study

Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making

T A K Gandamihardja et al. World J Surg. 2019 Feb.

Abstract

Background: Multidisciplinary team (MDT)-driven cancer care is a mandatory UK national policy, widely used globally. However, few studies have examined how MDT members make decisions as a team. We report a single-centre prospective study on team working within breast cancer MDT.

Methods: This was a prospective observational study of 10 breast MDT meetings (MDM). Trained clinical observer scored quality of presented information and disciplinary contribution to case reviews in real time, using a validated tool, namely Metric for the Observation of Decision-Making. Data were analysed to evaluate quality of team working.

Results: Ten MDMs were observed (N = 346 patients). An average of 42 patients were discussed per MDM (range: 29-51) with an average 3 min 20 s (range: 31 s-9 min) dedicated to each patient. Management decision was made in 99% of cases. In terms of contribution to case reviews, breast care nurses scored significantly (p < 0.05) lower (M = 1.79, SD = 0.12) compared to other team members (e.g. surgeons, M = 4.65; oncologists, M = 3.07; pathologists, M = 4.51; radiologists, M = 3.21). Information on patient psychosocial aspects (M = 1.69, SD = 0.68), comorbidities (M = 1.36, SD = 0.39) and views on treatment options (M = 1.47, SD = 0.34) was also significantly (p < 0.05) less well represented compared to radiology (M = 3.62, SD = 0.77), pathology (M = 4.42, SD = 0.49) and patient history (M = 3.91, SD = 0.48).

Conclusion: MDT evaluation via direct observation in a meeting is feasible and reliable. We found consistent levels of quality of information coverage and contribution within the team, but certain aspects could be improved. Contribution to patient review resides predominantly with surgeons, while presented patient information is largely of biomedical nature. These findings can be fed to cancer MDTs to identify potential interventions for improvement.

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Conflict of interest statement

Sevdalis is the director of London Safety and Training Solutions Ltd, which delivers human factors, patient safety and quality improvement advisory and training services to hospitals and training programs globally. James Green is a Director of Green Cross Medical Ltd that developed MDT FIT for use by National Health Service Cancer Teams in the UK.

Figures

Fig. 1
Fig. 1
Metric for the observation of decision-making in cancer multidisciplinary team meeting (MDT-MODe)
See this image and copyright information in PMC

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