Factors favouring palliative treatment multidisciplinary decisions for newly diagnosed visceral and soft tissue sarcomas

Multidisciplinary Approach to Older Adults with Hematologic Malignancies-a Paradigm Shift

Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.

Multidisciplinary team meeting in digestive oncology: when opinions differ

In daily oncology, Multidisciplinary Team (MDT) meetings are used worldwide to take every main decision. In order to improve the MDT efficiency, an analysis of decision-making process relying on patients refusing to undergo MDT proposal during presentations, in accordance with their referent specialist, was retrospectively performed in an academic and tertiary center, from 1995 to 2010. Out of 1000 patients, 0.5% refused the MDT proposal because of (1) ignorance of current evidence-based literature, (2) heterogeneous interpretations of the technical feasibility, and (3) the MDT undervaluing patient's specificities and wishes. In order to offset the MDT decision, patient needs to come from a well-off and educated background and to get the uttered support of the referent specialist. MDT conclusion is not customized because of interindividual exceptions and technical evaluations. Clinical Nurse Specialists attending to "blind" MDT meetings may help to back oncologic patient's specificities and wishes.

Multidisciplinary care in the oncology setting: historical perspective and data from lung and gynecology multidisciplinary clinics

Multidisciplinary care refers to a practice in which physicians from multiple specialties attend to the same patient population. There are many advantages to the model, including reduced time to treatment, coordinated treatment plans, increased patient and physician satisfaction, and increased enrollment onto clinical trials. At Central Dupage Hospital, multidisciplinary clinics have been instituted in lung and gynecologic cancer. We describe the structure and operation of each clinic and highlight their considerable success in improving patient care.

Quality of care management decisions by multidisciplinary cancer teams: a systematic review

BACKGROUND

Factors that affect the quality of clinical decisions of multidisciplinary cancer teams (MDTs) are not well understood. We reviewed and synthesised the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making.

METHODS

Electronic databases were searched in May 2009. Eligible studies reported original data, quantitative or qualitative. Data were extracted and tabulated by two blinded reviewers, and study quality formally evaluated.

RESULTS

Thirty-seven studies were included. Study quality was low to medium. Studies assessed quality of care decisions via the effect of MDTs on care management. MDTs changed cancer management by individual physicians in 2-52% of cases. Failure to reach a decision at MDT discussion was found in 27-52% of cases. Decisions could not be implemented in 1-16% of cases. Team decisions are made by physicians, using clinical information. Nursing personnel do not have an active role, and patient preferences are not discussed. Time pressure, excessive caseload, low attendance, poor teamworking and lack of leadership lead to lack of information and deterioration of decision-making. Telemedicine is increasingly used in developed countries, with no detriment to quality of MDT decisions.

CONCLUSIONS

Team/social factors affect management decisions by cancer MDTs. Inclusion of time to prepare for MDTs into team-members' job plans, making team and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings. These improvements ought to be considered at national policy level, with the ultimate aim of improving cancer care.

Decision making in surgical oncology

Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.