Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: Conversation analysis

Tayana Soukup; Ged Murtagh; Benjamin W. Lamb; James S.A. Green; Nick Sevdalis

doi:10.2147/JMDH.S270394

Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: Conversation analysis

Tayana Soukup^*, Ged Murtagh, Benjamin W. Lamb, James S.A. Green, Nick Sevdalis

^*Corresponding author for this work

Health Service & Population Research

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

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.

Original language	English
Pages (from-to)	411-424
Number of pages	14
Journal	Journal of Multidisciplinary Healthcare
Volume	14
DOIs	https://doi.org/10.2147/JMDH.S270394
Publication status	Published - 2021

Keywords

Cancer care
Cancer multidisciplinary team meetings
Decision-making
Fidelity

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2147/JMDH.S270394

Cite this

@article{d709f024724b42839fc22436686d3110,

title = "Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: Conversation analysis",

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 {\textquoteleft}Orientation-Discussion-Decision-Implementation{\textquoteright} framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK{\textquoteright}s Department of Health, UK{\textquoteright}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 {\textquoteleft}Orientation-Discussion-Decision-Implementation{\textquoteright} 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.",

keywords = "Cancer care, Cancer multidisciplinary team meetings, Decision-making, Fidelity",

author = "Tayana Soukup and Ged Murtagh and Lamb, {Benjamin W.} and Green, {James S.A.} and Nick Sevdalis",

note = "Funding Information: Financial support for this study was provided entirely by the UK?s National Institute for Health Research (NIHR) via the Imperial Patient Safety Translational Research Centre. TS and NS research is funded by the NIHR via the ?Applied Research Collaboration: South London? at King?s College Hospital NHS Foundation Trust, London, UK. NS is also a member of King?s Improvement Science, which offers co-funding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King?s College London. Its work is funded by King?s Health Partners (Guy?s and St Thomas? NHS Foundation Trust, King?s College Hospital NHS Foundation Trust, King?s College London and South London and Maudsley NHS Foundation Trust), Guy?s and St Thomas? Charity and the Maudsley Charity. The funding agreement ensured the authors? independence in designing the study, interpreting the data, writing, and publishing the report. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2021 Soukup et al. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

doi = "10.2147/JMDH.S270394",

language = "English",

volume = "14",

pages = "411--424",

journal = "Journal of Multidisciplinary Healthcare",

issn = "1178-2390",

publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings

T2 - Conversation analysis

AU - Soukup, Tayana

AU - Murtagh, Ged

AU - Lamb, Benjamin W.

AU - Green, James S.A.

AU - Sevdalis, Nick

N1 - Funding Information: Financial support for this study was provided entirely by the UK?s National Institute for Health Research (NIHR) via the Imperial Patient Safety Translational Research Centre. TS and NS research is funded by the NIHR via the ?Applied Research Collaboration: South London? at King?s College Hospital NHS Foundation Trust, London, UK. NS is also a member of King?s Improvement Science, which offers co-funding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King?s College London. Its work is funded by King?s Health Partners (Guy?s and St Thomas? NHS Foundation Trust, King?s College Hospital NHS Foundation Trust, King?s College London and South London and Maudsley NHS Foundation Trust), Guy?s and St Thomas? Charity and the Maudsley Charity. The funding agreement ensured the authors? independence in designing the study, interpreting the data, writing, and publishing the report. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care. Publisher Copyright: © 2021 Soukup et al. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Cancer care

KW - Cancer multidisciplinary team meetings

KW - Decision-making

KW - Fidelity

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DO - 10.2147/JMDH.S270394

M3 - Article

AN - SCOPUS:85101875532

SN - 1178-2390

VL - 14

SP - 411

EP - 424

JO - Journal of Multidisciplinary Healthcare

JF - Journal of Multidisciplinary Healthcare

ER -

Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: Conversation analysis

Abstract

Keywords

UN SDGs

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