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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.


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Diagram depicting the underlying components of decision-making processes in cancer multidisciplinary team meetings.
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Figure 2: Diagram depicting the underlying components of decision-making processes in cancer multidisciplinary team meetings.

Mentions: Table 3 presents the resulting factor pattern matrix. The highest-loading variables on the first factor were patient views on the treatment options (0.70), oncologists’ input into case discussion (0.67), nurses’ input into case discussion (0.65), and patient psychosocial aspects (0.60). Accordingly, this factor was labeled “Holistic and Clinical inputs,” representing patients’ holistic and clinical needs. The highest-loading variables on the second factor were patient radiological information presented to the team (0.91) and radiologists’ input into case discussion (0.93). Accordingly, this factor was labeled ‘Radiology’, representing radiological profile of patients’ disease. The highest-loading variables on the third factor were patient pathological information presented to the team (0.90) and pathologists’ input into case discussion (0.96). Accordingly, this factor was labeled “Pathology,” representing pathological profile of patients’ disease. The highest-loading variables on the fourth factor were coordinator's (0.68) and meeting chair's (0.61) inputs into case discussion. Accordingly, this factor was labeled “Meeting Management,” representing the management of case discussions within the meeting (chair), and general management and organization of cases for discussion (coordinator). Figure 2 shows a graphical representation of the 4-factor model.


The anatomy of clinical decision-making in multidisciplinary cancer meetings
Diagram depicting the underlying components of decision-making processes in cancer multidisciplinary team meetings.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Diagram depicting the underlying components of decision-making processes in cancer multidisciplinary team meetings.
Mentions: Table 3 presents the resulting factor pattern matrix. The highest-loading variables on the first factor were patient views on the treatment options (0.70), oncologists’ input into case discussion (0.67), nurses’ input into case discussion (0.65), and patient psychosocial aspects (0.60). Accordingly, this factor was labeled “Holistic and Clinical inputs,” representing patients’ holistic and clinical needs. The highest-loading variables on the second factor were patient radiological information presented to the team (0.91) and radiologists’ input into case discussion (0.93). Accordingly, this factor was labeled ‘Radiology’, representing radiological profile of patients’ disease. The highest-loading variables on the third factor were patient pathological information presented to the team (0.90) and pathologists’ input into case discussion (0.96). Accordingly, this factor was labeled “Pathology,” representing pathological profile of patients’ disease. The highest-loading variables on the fourth factor were coordinator's (0.68) and meeting chair's (0.61) inputs into case discussion. Accordingly, this factor was labeled “Meeting Management,” representing the management of case discussions within the meeting (chair), and general management and organization of cases for discussion (coordinator). Figure 2 shows a graphical representation of the 4-factor model.

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