Abstract
Background: Functional perspective of groups highlights the importance of understanding the relationship between internal factors that emanate from within a group (e.g. diversity and composition), the external circumstances that are intractable, such as workload and time pressures, and the quality of interactions between team members during a given task. This premise has not yet been explored in the context of patient-reviews in multidisciplinary tumor board (MTBs) meetings. We have therefore set out to gain better understanding of how external circumstances and internal factors relate to the quality of interactions in a clinically diverse group of health professionals.
Methods: Breast, colorectal and gynaecological tumor boards from across 3 teaching hospitals in the UK were video recorded over 12-weekly meetings encompassing 822 patient-reviews and totalling 55h of recorded meeting time. Quality of interactions for each of the 822 patient-reviews was assessed using a validated instrument, namely, Bales’ Interaction Process Analysis, that captures frequency of task-oriented and socio-emotional interactions during a team task. We also measured the following items:
• group size (number of core team members present at any one patient-review),
• disciplinary diversity (number of core disciplines present at any one patient-review),
• disciplinary distribution (number of core members present per core discipline), and
• gender balance (more males, more females, equal number of males and females)
• time and workload pressures (ratio based on the time left to discuss patients on the meeting agenda divided by the number of patients left to be discussed)
The relationship between the variables was assessed using partial correlation analysis controlling for team/tumour type and the complexity of the patient discussed (using a validated tool, MeDiC).
Participants were core members of the 3 MTBs comprising 41 team members in total including;
• 6 radiologists with on average 12 years’ experience,
• 5 histopathologists with on average 11 years’ experience,
• 12 surgeons with on average 8 years’ experience,
• 6 oncologists with on average 6 years’ experience, and
• 12 cancer specialist nurses with on average 7 years’ experience
Results: Disciplinary diversity and group size are significantly associated with reduced task oriented interactions such as sharing of patient related information (r=-.08, N=833, p<.05; r=.-.14, N=388, p<.05; respectively), and increased seeking of such information from the team (r=.13, N=833, p<.05; r=.08, N=833, p<.05; respectively). Group size and more male team members present during patient-reviews are also associated with increased seeking but of clinical opinions into care planning (r=.18, N=833, p<.05; r=.21, N=833, p<.05; respectively), while the opposite pattern was evident with more females present (r=-.16, N=833, p<.05)
Negative socio-emotional reactions such as antagonism heighten with disciplinary diversity (r=.08, N=833, p<.05) and tension also increased with team size (r=.1.1, N=3833, p<.05; r=.249, N=833, p<.05, respectively). Patient-reviews with more male team members present are associated with significantly more tension (r=.01, N=833, p<.05) and less disagreements (r=-.11), while the opposite relationship is evident when more females are present i.e. more disagreements (r=.10, N=833, p<.05) and less tension (r=-.11, N=833, p<.05).
Time-workload pressure is associated with reduced task-oriented interactions in particular providing less clinical opinions during patient-reviews (r=-.15, N=833, p<.05), and reduced positive socio-emotional interactions between team members such as solidarity (r=--.14, N=833, p<.05) and agreeableness (r=-.08, N=833, p<.05).
Discussion: Disciplinary diversity, team composition and time-workload pressures are important elements to take into consideration when evaluating MTBs since they affect the interaction quality in different ways. It is arguable that smaller size teams with only core disciplines present and streamlining workload to reduce time-workload pressure may be a more conducive set-up for ensuring better functioning and service quality in MTBs.
| Original language | English |
|---|---|
| Journal | Science of Team Science |
| Publication status | Published - May 2019 |
| Event | Science of Team Science - Michigan State University, USA, Michigan, United States Duration: 23 May 2019 → … https://www.inscits.org/2019-program |
