Effect of digital-enabled multidisciplinary therapy conferences on efficiency and quality of the decision making in prostate cancer care

Abstract

Objectives: To investigate the impact on efficiency and quality of preprostatectomy multidisciplinary therapy conferences (MDT) at Karolinska University Hospital related to the use of a digital solution compared with standard of care. Further, to explore whether gains in MDT efficiency and quality impact oncological or functional patient outcomes.

Methods: We conducted a prospective, observational study of preoperative prostate cancer MDT at Karolinska between February 2017 and March 2021, including 1329 patients. We compared efficiency and quality of the standard MDT and the MDT using the digital solution IntelliSpace Precision Medicine Multidisciplinary Team Orchestrator (ISPM) based on the previously used MDT-MODe approach. Clinical and patient-reported functional outcomes were derived from the medical records and the Swedish National Prostate Cancer Register.

Results: While ISPM was used during the MDT meeting, the time spent per patient was reduced by 24% (p<0.001) and most of the MDT-MODe items were scored significantly higher. There was a reduction in pelvic lymph-node dissection procedures in the ISPM cohort (p=0.001) and an increased proportion of unilateral nerve-sparing procedures (p=0.005), while all other outcome-related measures were not significantly different between the two patient groups.

Discussion and conclusion: To increase the value of the MDT, all data relevant for treatment decision need to be purposefully presented and compiled, which also enables secondary use of the data.The use of a digital solution during preoperative MDTs for prostate cancer decision making at Karolinska University Hospital improved the efficiency and quality of this multidisciplinary team meeting without impacting patient outcomes.

Keywords: Access to Information; Data Visualization; Decision Support Systems, Clinical.

Figure 1

ISPM dashboard as implemented and used in the prospective, observational study on the impact of a digital solution during the MDTs in the prostate cancer care flow at Karolinska University Hospital. Patient data are fictional and do not originate from a real person. BMI, body mass index; IIEF-5, International Index of Erectile Function; MDT, multidisciplinary therapy; ISPM, IntelliSpace Precision Medicine Multidisciplinary Team Orchestrator; MDT, multidisciplinary therapy; QOL, quality of life; PSA, prostate-specific antigen; PIRADS, Prostate Imaging-Reporting & Data System; MRC, magnetic resonance imaging conference.

Figure 2

A Time spent in the MDT meeting per patient in the baseline setting (164 patients) versus the ISPM setting (163 patients). Box plot with median and IQR; whiskers denote $\pm 1.5\times$IQR. ***P<0.001 (B): interaction between mean time (minutes) spent per patient and number of patients scheduled and discussed during the MDT. Dots indicate the mean durations at conferences with a particular number of patients being discussed. Regression lines are derived from 164 (baseline) and 163 (ISPM) patients per group. ISPM, IntelliSpace Precision Medicine Multidisciplinary Team Orchestrator; MDT, multidisciplinary therapy conference.

Figure 3

MDT-MODe items concerning information presentation. *P<0.05, **p<0.01. (B) MDT-MODe items concerning leadership and team interaction. ***P<0.001. (C) Percentage of staff members actively participating per patient case discussion and decision making in the MDT. *P<0.05 (D) Percentage of patients for which questions were raised during the MDT meeting to repeat already presented information. **P<0.01. ISPM, IntelliSpace Precision Medicine Multidisciplinary Team Orchestrator; MDT, multidisciplinary therapy conference; MDT-MODe, Metric of Decision-Making.