Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study.

OBJECTIVE: To explore the factors that influence treatment decision-making in a gynaecological cancer team (MDT).
DESIGN: Qualitative study using interviews and observations.
SETTING: Gynaecological cancer MDT meetings and participants' offices. SAMPLE: A gynaecological cancer MDT and members of that team.
METHODS: Observations of ten MDT meetings and semistructured interviews with 16 team members. Data analysis using the constant comparison technique of grounded theory and ethnography. MAIN OUTCOME MEASURES: Factors affecting treatment decisions in the MDT meetings.
RESULTS: Disease-centred information was central to decision-making, whereas patient-centred factors such as patient choice and co-morbidity were more peripheral. This was partly due to variation in team members' type and level of participation: senior clinicians occupied the most dominant roles in discussions and decision-making, whereas nurses contributed less but were more likely to focus on patient-related factors. Three main decision-making pathways emerged: a short discussion followed by a clear decision, a prolonged discussion ending in a definite treatment plan, and a lengthy discussion with no clearly stated decision at the end. The type of pathway followed depended on a case's complexity and the extent of agreement among team members.
CONCLUSIONS: The process of treatment decision-making was not consistent for all women but was affected by factors such as the complexity of the case, which team members participated, and the extent of team members' agreement. Improvements are needed to ensure patient-centred information is included for all women and that clear decisions are reached and recorded in all cases.