James S A Green1, Nick Sevdalis2, Tayana Soukup2, Ged Murtagh3, Benjamin W Lamb4,5. 1. Whipps Cross University Hospital, Barts Health NHS Trust, London, UK. 2. Centre for Implementation Science, King's College London, London, UK. 3. Imperial College London, London, UK. 4. Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 5. Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom.
Abstract
PURPOSE: Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the 'Orientation-Discussion-Decision-Implementation' framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK's Department of Health, UK's National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. PATIENTS AND METHODS: This is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the 'Orientation-Discussion-Decision-Implementation' framework, and the cancer guidelines. RESULTS: Eight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team. CONCLUSION: We found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guidelines, and just over 10% not adhering to the group decision-making framework. The findings are in line with the UK recommendation on streamlining MDT meetings and could help decide how to re-organise the meetings to be most efficient. Implications are discussed in relation to quality and safety of care.
PURPOSE: Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the 'Orientation-Discussion-Decision-Implementation' framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK's Department of Health, UK's National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. PATIENTS AND METHODS: This is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the 'Orientation-Discussion-Decision-Implementation' framework, and the cancer guidelines. RESULTS: Eight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team. CONCLUSION: We found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guidelines, and just over 10% not adhering to the group decision-making framework. The findings are in line with the UK recommendation on streamlining MDT meetings and could help decide how to re-organise the meetings to be most efficient. Implications are discussed in relation to quality and safety of care.
Authors: Benjamin W Lamb; Katrina F Brown; Kamal Nagpal; Charles Vincent; James S A Green; Nick Sevdalis Journal: Ann Surg Oncol Date: 2011-03-26 Impact factor: 5.344
Authors: Tayana Soukup; Konstantinos V Petrides; Benjamin W Lamb; Somita Sarkar; Sonal Arora; Sujay Shah; Ara Darzi; James S A Green; Nick Sevdalis Journal: Medicine (Baltimore) Date: 2016-06 Impact factor: 1.889
Authors: Rosalind Raine; Penny Xanthopoulou; Isla Wallace; Caoimhe Nic A' Bháird; Anne Lanceley; Alex Clarke; Gill Livingston; Archie Prentice; Dave Ardron; Miriam Harris; Michael King; Susan Michie; Jane M Blazeby; Natalie Austin-Parsons; Simon Gibbs; Julie Barber Journal: BMJ Qual Saf Date: 2014-06-09 Impact factor: 7.035
Authors: David Winston Hamilton; Benjamin Heaven; Richard Thomson; Janet Wilson; Catherine Exley Journal: BMJ Open Date: 2022-08-24 Impact factor: 3.006
Authors: Erik Ronmark; Ralf Hoffmann; Viktor Skokic; Maud de Klerk-Starmans; Fredrik Jaderling; Pieter Vos; Maudy C W Gayet; Hans Hofstraat; Marco Janssen; Olof Akre; Per Henrik Vincent Journal: BMJ Health Care Inform Date: 2022-08