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The anatomy of clinical decision-making in multidisciplinary cancer meetings

View Article: PubMed Central - PubMed

ABSTRACT

In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable.

The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision.

This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons.

We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis.

The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001).

Hawthorne effect is the main limitation of the study.

The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core disciplines. Evidence of dual-task interference was observed in relation to the meeting chairs’ input and their corresponding surgical input into case reviews.

No MeSH data available.


Related in: MedlinePlus

Metric for the observation of decision-making used to assess case discussions in cancer multidisciplinary team meetings.[4]
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Figure 1: Metric for the observation of decision-making used to assess case discussions in cancer multidisciplinary team meetings.[4]

Mentions: Case reviews within each meeting and across all 4 cancer teams were assessed in the same manner by assessors who were clinicians specialized in the cancer they observed, and trained beforehand in the use of the MDT-MODe, a quantitative observational assessment tool (Fig. 1).[4] Training in the use of the tool is essential to be able to use it—this is a general principle for instruments assessing human factors in clinical environments, such that the evaluations produced have a degree of accuracy and can be meaningfully used.[29] The tool has been validated, and previously used to assess various cancer MDTs.[26–28] The instrument allows a trained evaluator (using the form shown in Fig. 1) to provide for each case review carried out by the MDT a standardized score on a 1 to 5 behaviorally anchored scale of the following variables in real-time:


The anatomy of clinical decision-making in multidisciplinary cancer meetings
Metric for the observation of decision-making used to assess case discussions in cancer multidisciplinary team meetings.[4]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998467&req=5

Figure 1: Metric for the observation of decision-making used to assess case discussions in cancer multidisciplinary team meetings.[4]
Mentions: Case reviews within each meeting and across all 4 cancer teams were assessed in the same manner by assessors who were clinicians specialized in the cancer they observed, and trained beforehand in the use of the MDT-MODe, a quantitative observational assessment tool (Fig. 1).[4] Training in the use of the tool is essential to be able to use it—this is a general principle for instruments assessing human factors in clinical environments, such that the evaluations produced have a degree of accuracy and can be meaningfully used.[29] The tool has been validated, and previously used to assess various cancer MDTs.[26–28] The instrument allows a trained evaluator (using the form shown in Fig. 1) to provide for each case review carried out by the MDT a standardized score on a 1 to 5 behaviorally anchored scale of the following variables in real-time:

View Article: PubMed Central - PubMed

ABSTRACT

In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable.

The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision.

This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons.

We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis.

The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001).

Hawthorne effect is the main limitation of the study.

The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core disciplines. Evidence of dual-task interference was observed in relation to the meeting chairs’ input and their corresponding surgical input into case reviews.

No MeSH data available.


Related in: MedlinePlus