Jenny Harris1, Cath Taylor1, Nick Sevdalis2, Rozh Jalil3, James S A Green4. 1. Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK. 2. Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK. 3. Urology department, Imperial College NHS Trust, London, UK. 4. Department of Urology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK Department of Health and Social Care, London South Bank University, London, UK.
Abstract
OBJECTIVE: To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. DESIGN: Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. SETTING: Study 2 included 10 cancer MDMs in England. PARTICIPANTS: Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. INTERVENTION: None. MAIN OUTCOME MEASURES: Tool development, validity, reliability/agreement and variability in MDT performance. RESULTS: Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance (P ≤ 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (≥80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6-7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs (P ≤ 0.01). CONCLUSIONS: MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance.
OBJECTIVE: To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. DESIGN: Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. SETTING: Study 2 included 10 cancer MDMs in England. PARTICIPANTS: Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. INTERVENTION: None. MAIN OUTCOME MEASURES: Tool development, validity, reliability/agreement and variability in MDT performance. RESULTS: Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance (P ≤ 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (≥80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6-7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs (P ≤ 0.01). CONCLUSIONS: MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance.
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