Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments

TY - JOUR

T1 - Quality Improvement in Multidisciplinary Cancer Teams

T2 - An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments

AU - Lamb, B. W.

AU - Sevdalis, Nick

AU - Mostafid, H.

AU - Vincent, C.

AU - Green, J. S. A.

PY - 2011/12

Y1 - 2011/12

N2 - Purpose: Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members' contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.Materials and Methods: Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients' views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere-Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman's correlations.Results: Quality of information presentation: Case histories and radiology information rated highest; patients' views and comorbidities/psychosocial issues rated lowest (observed: Z = 14.80, P a parts per thousand currency sign 0.001; self-report: Z = 3.70, P <0.001). Contribution to decision-making: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed: Z = 20.00, P a parts per thousand currency sign 0.001; self-report: Z = 8.10, P <0.001). Correlations between observational and self-report assessments: Median Spearman's rho = 0.74 (range = 0.66-0.91; P <0.05).Conclusions: The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.

AB - Purpose: Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members' contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.Materials and Methods: Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients' views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere-Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman's correlations.Results: Quality of information presentation: Case histories and radiology information rated highest; patients' views and comorbidities/psychosocial issues rated lowest (observed: Z = 14.80, P a parts per thousand currency sign 0.001; self-report: Z = 3.70, P <0.001). Contribution to decision-making: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed: Z = 20.00, P a parts per thousand currency sign 0.001; self-report: Z = 8.10, P <0.001). Correlations between observational and self-report assessments: Median Spearman's rho = 0.74 (range = 0.66-0.91; P <0.05).Conclusions: The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.

KW - OPERATING-ROOM

KW - SURGICAL-TEAMS

KW - LUNG-CANCER

KW - IMPACT

KW - MANAGEMENT

KW - SAFETY

KW - SURVIVAL

U2 - 10.1245/s10434-011-1773-5

DO - 10.1245/s10434-011-1773-5

M3 - Article

SN - 1068-9265

VL - 18

SP - 3535

EP - 3543

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 13

ER -