Abstract
Background
Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patients. While they are standard cancer care policy in many countries and recommended worldwide, the way these teams make decisions remains rather little studied and poorly understood. The study we report here aims to address this gap. We apply the ‘orientation-discussion-decision-implementation’ (ODDI) model of team decision-making to cancer MDTs and we argue that to achieve high-quality team-based decision-making, these teams need to engage in a consistent and structured manner in (1) problem identification, (2) discussion, (3) decision reaching and (4) implementation. We investigate the degree to which cancer MDTs consistently engage in these stages of group decision-making, and the underlying interaction formats that they employ in real-time case reviews in their weekly care planning meetings.
Methods
This is a prospective observational study. Breast, colorectal and gynaecological cancer teams in the Greater London and Derbyshire (UK) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were analysed according to the ODDI model using descriptive statistics and frequency counts.
Findings and Conclusions
Eight formats of team interaction during decision-making were identified during decision-making with the least common (8% of case reviews) being multidisciplinary (i.e. including all core disciplines formally required to attend MDMs). Overall, most patients (54%) were reviewed between two or three disciplines only of those present. While all patients put forward for MDM in the study received a discussion, a small percentage (4%) either bypassed orientation phase of the ODDI model (i.e., case presentation) and went straight into discussing the patient, or they did not explicitly state the decision to the entire team (8%). Disciplines most consistently engaged in all phases of the ODDI model were surgeons (83%) and oncologists (8%), hence case reviews were led either by surgeons (75%), or by oncologists (4%) or jointly by surgeons-oncologists (21%).
We conclude that despite MDTs being a set policy in the UK, actual case reviews are not truly MDT-driven. We discuss quality of care implications for cases where the orientation and decision stages of the ODDI model were compromised; and propose a method to select complex patients for MDT review such that the most complex cases only are reviewed by the MDT to allow true team-based decisions).
Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patients. While they are standard cancer care policy in many countries and recommended worldwide, the way these teams make decisions remains rather little studied and poorly understood. The study we report here aims to address this gap. We apply the ‘orientation-discussion-decision-implementation’ (ODDI) model of team decision-making to cancer MDTs and we argue that to achieve high-quality team-based decision-making, these teams need to engage in a consistent and structured manner in (1) problem identification, (2) discussion, (3) decision reaching and (4) implementation. We investigate the degree to which cancer MDTs consistently engage in these stages of group decision-making, and the underlying interaction formats that they employ in real-time case reviews in their weekly care planning meetings.
Methods
This is a prospective observational study. Breast, colorectal and gynaecological cancer teams in the Greater London and Derbyshire (UK) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were analysed according to the ODDI model using descriptive statistics and frequency counts.
Findings and Conclusions
Eight formats of team interaction during decision-making were identified during decision-making with the least common (8% of case reviews) being multidisciplinary (i.e. including all core disciplines formally required to attend MDMs). Overall, most patients (54%) were reviewed between two or three disciplines only of those present. While all patients put forward for MDM in the study received a discussion, a small percentage (4%) either bypassed orientation phase of the ODDI model (i.e., case presentation) and went straight into discussing the patient, or they did not explicitly state the decision to the entire team (8%). Disciplines most consistently engaged in all phases of the ODDI model were surgeons (83%) and oncologists (8%), hence case reviews were led either by surgeons (75%), or by oncologists (4%) or jointly by surgeons-oncologists (21%).
We conclude that despite MDTs being a set policy in the UK, actual case reviews are not truly MDT-driven. We discuss quality of care implications for cases where the orientation and decision stages of the ODDI model were compromised; and propose a method to select complex patients for MDT review such that the most complex cases only are reviewed by the MDT to allow true team-based decisions).
| Original language | English |
|---|---|
| Journal | PsyArXiv |
| DOIs | |
| Publication status | Published - 14 Apr 2019 |
