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. 2020 Jul;9(14):5143-5154.
doi: 10.1002/cam4.3026. Epub 2020 May 31.

A measure of case complexity for streamlining workflow in multidisciplinary tumor boards: Mixed methods development and early validation of the MeDiC tool

Tayana Soukup  1 , Abigail Morbi  2   3 , Benjamin W Lamb  4 , Tasha A K Gandamihardja  5 , Katy Hogben  6 , Katia Noyes  7 , Ted A Skolarus  8 , Ara Darzi  3 , Nick Sevdalis  1 , James S A Green  1   9
Affiliations

A measure of case complexity for streamlining workflow in multidisciplinary tumor boards: Mixed methods development and early validation of the MeDiC tool

Tayana Soukup et al. Cancer Med. 2020 Jul.

Abstract

Background and objective: There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned; however, no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool.

Methods: We used a mixed-methods approach involving psychometric evaluation and expert review to develop the Measure of case-Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in six phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert-team reviews.

Results: Phase-1: case complexity factors identified through literature review and expert interviews; Phase-2: 51 factors subjected to iterative review and content validation by nine cancer teams across four England Trusts with nine further items identified; Phase 3: 60 items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey; Phases 5 and 6: excellent interassessor reliability between clinical and nonclinical observers, and adequate validity on 903 video case discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC.

Conclusions: MeDiC is an evidence-based and expert-driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization.

Keywords: case complexity; decision making; multidisciplinary team meetings; optimization; streamlining; tumor boards; workload.

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Conflict of interest statement

BL and TS received funding for training cancer multidisciplinary teams in the assessment and quality improvement methods in the United Kingdom. TS serves as a consultant to F. Hoffmann‐La Roche Ltd Diagnostics providing advisory research services in relation to innovations for multidisciplinary tumor boards. NS is the Director of London Safety & Training Solutions Ltd, which provides teamworking, patient safety, and improvement skills training and advice on a consultancy basis to hospitals and training programs in the United Kingdom and internationally. JG is a Director of Green Cross Medical Ltd that developed MDT FIT for use by National Health Service Cancer Teams in the UK. The other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Development of the Measure of Case‐Discussion Complexity (MeDiC) Tool for multidisciplinary tumor board team meetings. Reprinted with permission from Soukup, 2017. 17
Figure 2
Figure 2
Example of how Measure of case‐Discussion Complexity (MeDiC) could be used to streamline workload
See this image and copyright information in PMC

References

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