Open AccessAnalysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision‐Making
Author(s) -
Gandamihardja T. A. K.,
Soukup T.,
McInerney S.,
Green J. S. A.,
Sevdalis N.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4815-3
Subject(s) - medicine , breast cancer , observational study , prospective cohort study , multidisciplinary team , multidisciplinary approach , psychosocial , cardiothoracic surgery , abdominal surgery , cancer , general surgery , medical physics , surgery , nursing , social science , psychiatry , sociology
Abstract Background Multidisciplinary team (MDT)‐driven cancer care is a mandatory UK national policy, widely used globally. However, few studies have examined how MDT members make decisions as a team. We report a single‐centre prospective study on team working within breast cancer MDT. Methods This was a prospective observational study of 10 breast MDT meetings (MDM). Trained clinical observer scored quality of presented information and disciplinary contribution to case reviews in real time, using a validated tool, namely Metric for the Observation of Decision‐Making. Data were analysed to evaluate quality of team working. Results Ten MDMs were observed ( N = 346 patients). An average of 42 patients were discussed per MDM (range: 29–51) with an average 3 min 20 s (range: 31 s–9 min) dedicated to each patient. Management decision was made in 99% of cases. In terms of contribution to case reviews, breast care nurses scored significantly ( p < 0.05) lower ( M = 1.79, SD = 0.12) compared to other team members (e.g. surgeons, M = 4.65; oncologists, M = 3.07; pathologists, M = 4.51; radiologists, M = 3.21). Information on patient psychosocial aspects ( M = 1.69, SD = 0.68), comorbidities ( M = 1.36, SD = 0.39) and views on treatment options ( M = 1.47, SD = 0.34) was also significantly ( p < 0.05) less well represented compared to radiology ( M = 3.62, SD = 0.77), pathology ( M = 4.42, SD = 0.49) and patient history ( M = 3.91, SD = 0.48). Conclusion MDT evaluation via direct observation in a meeting is feasible and reliable. We found consistent levels of quality of information coverage and contribution within the team, but certain aspects could be improved. Contribution to patient review resides predominantly with surgeons, while presented patient information is largely of biomedical nature. These findings can be fed to cancer MDTs to identify potential interventions for improvement.