The Next Step Toward Patient-Centeredness in Multidisciplinary Cancer Team Meetings: An Interview Study with Professionals

Abstract

Background: Patient-centeredness is essential in complex oncological multidisciplinary team decision-making. Improvement seems to be needed, while there is a lack of knowledge about health care providers' needs for improvement.

Objective: To explore multidisciplinary team members' perspectives on the need to improve patient-centeredness in complex decision-making, and subsequently the strategies to enhance it.

Methods: This was a qualitative descriptive interview study. The participants were twenty-four professionals who attended multidisciplinary cancer team meetings weekly. The setting was five multidisciplinary teams (gastrointestinal, gynecological, urological, head and neck, and hematological cancer) in a Dutch academic hospital. Data were collected by semi-structured interviews and were analyzed with a combination of inductive and deductive content analysis.

Results: The participants voiced the need for additional information (patient-centered information, patients's needs and preferences, individualized medical information) during the multidisciplinary team meeting, to be more patient-centered in the decision-making conversation with the patient following the meeting, and for more information following the meeting to support patient-centeredness. The strategies, which mostly originated from the needs, were categorized as organization, decision-making, and communication. The most prominent strategies were those aimed at collecting and using patient-centered information, and to facilitate the decision-making conversation with the patient following the multidisciplinary team meeting.

Conclusion: Our findings highlighted the need to improve patient-centeredness in oncological multidisciplinary teams and provided a comprehensive overview of strategies for improvement, supported by multidisciplinary team members. These strategies emphasize involvement of patients throughout the continuous process of decision-making for patients with cancer. These strategies may be implemented in other oncological multidisciplinary teams, taking in mind the local needs. Future research may help to prioritize the strategies and to determine and evaluate the effect on endpoints, like patient or professional satisfaction, shared decision-making, and on the decision that was made.

Keywords: cancer; decision-making; multidisciplinary team; patient care; patient care team; patient-centered care.

Figure 1

Cancer-related decision-making process. At suspicion of malignancy the physician discusses the possible diagnosis and treatment options with the patient (team talk and, if possible, option talk). Patient-centered information is acquired (preference talk) and additional diagnostics are ordered. The treating physician discusses the patient case in the MDT meeting, where an advice is formulated and well-documented. The team aims to align MDT decision-making with Shared Decision-Making with the patient. Then, the physician translates the MDT advice to the patient and integrates this with the patient towards a personalized treatment plan. Options are explained with pros and cons (option talk) and preferences are discussed (preference talk). The treatment is applied. During decision-making or treatment, the MDT may be consulted again, when necessary.