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Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Multidisciplinary teams (MDTs) are the standard means of making clinical decisions in surgical oncology. The aim of this study was to explore the views of MDT members regarding contribution to the MDT, representation of patients’ views, and dealing with disagreements in MDT meetings—issues that affect clinical decision making, but have not previously been addressed.

Methods

Responses to open questions from a 2009 national survey of MDT members about effective MDT working in the United Kingdom were analyzed for content. Emergent themes were identified and tabulated, and verbatim quotes were extracted to validate and illustrate themes.

Results

Free-text responses from 1,636 MDT members were analyzed. Key themes were: (1) the importance of nontechnical skills, organizational support, and good relationships between team members for effective teamworking; (2) recording of disagreements (potentially sharing them with patients) and the importance of patient-centered information in relation to team decision making; (3) the central role of clinical nurse specialists as the patient’s advocates, complementing the role of physicians in relation to patient centeredness.

Conclusions

Developing team members’ nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration.

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References

  1. The Department of Health. Manual for cancer services. London: The Department of Health; 2004.

    Google Scholar 

  2. McAvoy B. Optimising cancer care in Australia. Melbourne: National cancer control initiative. Aust Fam Physician. 2003;32:369–72.

    PubMed  Google Scholar 

  3. American College of Surgeons: commission on cancer. Cancer program standards. Chicago: American College of Surgeons; 2004, revised 2009. Available at: http://facs.org/cancer/coc/cocprogramstandards.pdf.

  4. Wright FC, De Vito C, Langer B, Hunter A. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007;43:1002–10.

    Article  PubMed  CAS  Google Scholar 

  5. Chan WF, Cheung PS, Epstein RJ, Mak J. Multidisciplinary approach to the management of breast cancer in Hong Kong. World J Surg. 2007;30:2095–2100.

    Article  Google Scholar 

  6. Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary care team working in cancer: what is the evidence? BMJ. 2010;340:c951. doi: 10.1136/bmj.c951.

    Article  PubMed  Google Scholar 

  7. Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7:935–43.

    Article  PubMed  Google Scholar 

  8. Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25.

    Article  PubMed  Google Scholar 

  9. Haward R, Amir Z, Borrill C, Dawson J, Scully J, West M, et al. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer. 2003;89:15–22.

    Article  PubMed  CAS  Google Scholar 

  10. Davies AR, Deans DA, Penman I, Plevris JN, Fletcher J, Wall L, et al. The multidisciplinary care team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19:496–503.

    Article  PubMed  CAS  Google Scholar 

  11. Newman EA, Guest AB, Helvie MA, Roubidoux MA, Chang AE, Kleer CG, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107:2346–2351.

    Article  PubMed  Google Scholar 

  12. Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17:457–460.

    Article  PubMed  CAS  Google Scholar 

  13. Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis. 2008;10:769–72.

    Article  PubMed  CAS  Google Scholar 

  14. Butow P, Harrison JD, Choy ET, Young JM, Spillane A, Evans A. Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer. 2007;110:1937–1944.

    Article  PubMed  Google Scholar 

  15. Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012 Apr 26;344:e2718. doi: 10.1136/bmj.e2718.

    Article  Google Scholar 

  16. Hong NJ, Wright FC, Gagliardi AR, Paszat LF. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J Surg Oncol. 2010;102:125–134.

    Article  PubMed  Google Scholar 

  17. Houssami N, Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer. 2006;42:2480–91.

    Article  PubMed  Google Scholar 

  18. The Department of Health. NHS England: percentage compliance with peer review by multidisciplinary care team against measures within the manual for cancer services 2004. Leeds: The Department of Health. 2009. Available at: http://data.gov.uk/dataset/england-nhs-indicator-percentage-compliance-with-peer-review-by-team-breast-lung-colorectal-local-an.

  19. Tschan F, Semmer NK, Gurtner A, Bizzari L, Spychiger M, Breuer M, et al. Explicit reasoning, confirmation bias, and illusory transactive memory. A simulation study of group medical decision making. Small Group Res. 2009;40:271–300.

    Article  Google Scholar 

  20. Larson JR, Christensen C, Franz TM, Abbott AS. Diagnosing groups: the pooling, management, and impact of shared and unshared case information in team-based medical decision making. J Personal Soc Psychol. 1998;75:93–108.

    Article  Google Scholar 

  21. Schulz-Hardt S, Brodbeck FC, Mojzisch A, Kerschreiter R, Frey D. Group decision making in hidden profile situations: dissent as a facilitator for decision quality. J Personal Soc Psychol. 1996;91:1080–93.

    Google Scholar 

  22. Christensen C, Abbott AS. Team medical decision making. In: Chapman GB, Sonnenberg FA, editors. Decision making in health care. Cambridge: Cambridge University Press; 2000. p. 267–85.

    Google Scholar 

  23. Orasanu J, Salas E. Team decision making in complex environments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Stamford: Ablex; 1995. p. 327–45.

    Google Scholar 

  24. NHS National Cancer Action Team. Multidisciplinary care team members views about MDT working: Results from a survey commissioned by the National Cancer Action Team. London: NHS National Cancer Action Team; 2009. Available at: http://www.ncin.org.uk/cancer_type_and_topic_specific_work/multidisciplinary_teams/MDT_development.aspx.

  25. Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JS. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol. 2012;23:1293–300.

    Article  PubMed  CAS  Google Scholar 

  26. NHS National Cancer Action Team. The characteristics of an effective multidisciplinary care team (MDT). London: NHS National Cancer Action Team; 2010. Available at: http://www.ncin.org.uk/cancer_type_and_topic_specific_work/multidisciplinary_teams/MDT_development.aspx.

  27. Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–116.

    Article  PubMed  CAS  Google Scholar 

  28. Flin R, O’Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Surrey: Ashgate; 2008.

    Google Scholar 

  29. Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116:511–517.

    Article  PubMed  CAS  Google Scholar 

  30. Lanceley A, Savage J, Menon U, Jacobs I. Influences on multidisciplinary care team decision-making. Int J Gynecol Cancer. 2008;18:215–22.

    Article  PubMed  CAS  Google Scholar 

  31. Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multidisciplinary breast cancer care teams. Eur J Oncol Nurs. 2004;8:306–314.

    Article  PubMed  CAS  Google Scholar 

  32. Junnola T, Eriksson E, Salantera S, Lauri S. Nurses’ decision-making in collecting information for the assessment of patients’ nursing problems. J Clin Nurs. 2002;11:186–96.

    Article  PubMed  Google Scholar 

  33. Lamb B, Sevdalis N. How do nurses make decisions? Int J Nurs Stud. 2010;48:281–284.

    Article  PubMed  Google Scholar 

  34. Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the cancer nurse specialist in the urology multidisciplinary care team meeting. Int J Urol Nurs. 2011;5:59–64.

    Article  Google Scholar 

  35. The center for informed choice at The Dartmouth Institute, USA. http://tdi.dartmouth.edu/centers/informed-choice/about/. Accessed 15 Dec 2011.

  36. Making good decisions in collaboration with patients (MAGIC), UK. http://www.making-good-decisions.org/. Accessed 15 Dec 2011.

  37. Sevdalis N, Harvey N. Predicting preferences: a neglected aspect of shared decision-making. Health Expect. 2006;9:245–51.

    Article  PubMed  Google Scholar 

  38. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R, et al. Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Technol Work. 2004;6:165–71.

    Article  Google Scholar 

  39. Künzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behaviour: A literature review. Safety Sci. 2010;48:1–17.

    Article  Google Scholar 

  40. Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA. Teamwork in the operating theatre: cohesion or confusion? J Eval Clin Pract. 2006;12:182–189.

    Article  PubMed  Google Scholar 

  41. Lamb BW, Wong H, Vincent C, Green JS, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf. 2011;20:849–56.

    Article  PubMed  Google Scholar 

  42. Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Teamwork and clinical decision-making in multidisciplinary cancer teams: prospective multimethod investigation using cross-validated assessment tools. Ann Surg Oncol. 2011;18(13):3535–3543. doi:10.1245/s10434-011-1773-5.

    Google Scholar 

  43. Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making in multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35:1970–6.

    Article  PubMed  Google Scholar 

  44. Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh). 2007;127:82–7.

    Article  Google Scholar 

  45. Lutterbach J, Pagenstecher A, Spreer J, Hetzel A, Velthoven V, Nikkhah G, et al. The brain tumor board: lessons to be learned from an interdisciplinary conference. Onkologie. 2005;28:22–6.

    Article  PubMed  Google Scholar 

  46. Sidhom M, Poulsen M. Group decisions in oncology: doctors’ perceptions of the legal responsibilities arising from multidisciplinary meetings. J Med Imaging Radiat Oncol. 2008;52:287–92.

    Article  PubMed  CAS  Google Scholar 

  47. Jarboe S. Procedures for enhancing team decision making. In: Hirokawa RY, Poole MS, editors. Communication and group decision making (2nd ed.). Thousand Oaks: Sage; 1996.

    Google Scholar 

  48. Duffy L. Team decision-making biases: an information-processing perspective. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Norwood: Ablex; 1995. p. 346–59.

    Google Scholar 

  49. Devitt B, Philip J, McLachlan SA. Team dynamics, decision making, and attitudes toward multidisciplinary cancer meetings: health professionals’ perspectives. J Oncol Pract. 2010;6:e17–e20.

    Article  PubMed  Google Scholar 

  50. Look Hong NJ, Gagliardi AR, Bronskill SE, Paszat LF, Wright FC. Multidisciplinary cancer conferences: exploring obstacles and facilitators to their implementation. J Oncol Pract. 2010;6:61–68.

    Article  PubMed  Google Scholar 

  51. Lamb BW, Sevdalis N, Vincent C, Green JSA. Development and evaluation of a checklist to support decision-making in cancer multidisciplinary team meetings: MDT-QuIC. Ann Surg Oncol. 2012;19:1759–65.

    Article  PubMed  CAS  Google Scholar 

  52. Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18:71–5.

    Article  PubMed  Google Scholar 

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Acknowledgment

We are grateful to the National Cancer Action Team, who provided access to data from their original survey, which they designed, administered, and analyzed. This research was supported by the National Institute for Health Research through the Imperial Centre for Patient Safety and Service Quality and Whipps Cross University Hospital NHS Trust Urology and R & D Departments.

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The authors report no conflict of interest.

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Correspondence to B. W. Lamb MRCS.

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Lamb, B.W., Taylor, C., Lamb, J.N. et al. Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study. Ann Surg Oncol 20, 1408–1416 (2013). https://doi.org/10.1245/s10434-012-2676-9

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