Introduction
In recent decades, the organisation of care for patients with cancer has changed significantly worldwide. There has been a shift from different specialties all working within their own silo, to integrated multidisciplinary care,1 which is particularly reflected in the emergence of oncological multidisciplinary team meetings (MDTMs).2 In these—often weekly—meetings, the outcome of diagnostic procedures is discussed with the intention of arriving at a final diagnosis and treatment plan. Medical specialists from all the involved specialties, including a surgical, medical and radiation oncologist, radiologist, nuclear radiologist and pathologist are present at MDTMs.3 In addition, in teaching hospitals, residents (defined as qualified doctors in training to become medical specialists) from all these specialties are also present.3 In many countries, there are also administrative support and clinical nurse practitioner (CNS) present.3 4
Discussing a patient in the MDTM is a central point in the treatment trajectory, as it contributes to adequate tumour staging, improves decision making about the most appropriate treatment plan, enhances communication between involved departments and contributes to efficient planning.4–6 Limited evidence even suggests an improvement in patients’ overall survival after being discussed in an MDTM.5 Most national guidelines worldwide, therefore, recommend that all patients with cancer should be discussed at least once in an MDTM.7–9 In some cases, a patient is discussed several times: preoperatively to discuss diagnostics and treatment plan, postoperatively to determine the pathological tumour-node-metastasis stage and follow-up plan, in the event of recurrent disease and in the palliative phase.7 Sometimes a patient is the subject of discussion in different MDTMs (eg, in a local and a regional MDTM).10 Although patients can be discussed in general MDTMs dealing with different tumour types, it is increasingly common to discuss cases in tumour-type specific MDTMs.3 The duration of the meetings varies, usually between 1 and 2 hours, with an average of 2 min discussion time per patient.11 Furthermore, the number of different patients to be discussed is growing rapidly due to the ever-increasing incidence and prevalence of cancer and the increasing number of multidisciplinary treatment options.12 13
Discussing a large number of patients in an MDTM requires a substantial investment in terms of effort and time on the part of the medical specialists and residents involved and accentuates the need to perform MDTMs efficiently. However, this is not self-evident: MDTMs have simply been introduced in cancer care without the development of formal training programmes.14 15 Participants are expected to possess competences such as multidisciplinary collaboration and communication, while Fahim et al16 found that the lack of such competences impairs the decision-making process in MDTMs.16 Residents are expected to learn to participate in MDTMs according to the master-apprentice principle, in other words they learn on the job.17 This seems insufficient given that their ‘masters’ might not have the necessary skills, nor will it necessarily make them into excellent models for future residents.18
In summary, MDTMs are under pressure and optimal execution is not evident. Existing templates on how to perform an MDTM are based on the Calman-Hine report (1995), which described principles about how to organise and structure high-quality multidisciplinary care.1 Following this, in 2010 the British National Cancer Action Team (NCAT) came with a report with 86 recommendations, divided into 5 domains (ie, the team, infrastructure for meetings, meeting organisation and logistics, patient-centred clinical decision-making and team governance) on how to effectively set up and implement an MDTM.19 However, these recommendations are based on a survey with 2000 multidisciplinary team members in the UK, and not based on an interventional study on MDTM-effectiveness.
Therefore, there is no clear definition for the execution of an optimal MDTM. However, the experiences of MDTM participants can provide us the necessary insights into factors that contribute to the MDTM quality. The aim of this study is therefore to identify what, according to medical specialists and residents, the facilitating and hindering factors are for the performance of an efficient, competent and high-quality MDTM. This should be the starting point for determining the improvements needed to make MDTMs future-proof. This study focuses on oncological MDTMs. However, MDTMs are executed throughout healthcare and therefore this study serves as an example for conducting optimal multidisciplinary collaboration in general.