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Karnatz N, Schwerter M, Liu S, Parviz A, Wilkat M, Rana M. Mixed Reality as a Digital Visualisation Solution for the Head and Neck Tumour Board: Application Creation and Implementation Study. Cancers (Basel) 2024; 16:1392. [PMID: 38611070 PMCID: PMC11011089 DOI: 10.3390/cancers16071392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
The preparation and implementation of interdisciplinary oncological case reviews are time-consuming and complex. The variety of clinical and radiological information must be presented in a clear and comprehensible manner. Only if all relevant patient-specific information is demonstrated in a short time frame can well-founded treatment decisions be made on this basis. Mixed reality (MR) technology as a multimodal interactive user interface could enhance understanding in multidisciplinary collaboration by visualising radiological or clinical data. The aim of the work was to develop an MR-based software prototype for a head and neck tumour board (HNTB) to support clinical decision-making. The article describes the development phases and workflows in the planning and creation of a MR-based software prototype that were required to meet the multidisciplinary characteristics of a HNTB.
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Affiliation(s)
- Nadia Karnatz
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | | | - Shufang Liu
- Brainlab AG, Olof-Palme-Str. 9, 81829 München, Germany
| | - Aida Parviz
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | - Max Wilkat
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | - Majeed Rana
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
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Brown S, Johnson K, Gray J, Bate J. Patient and parent perspectives on paediatric cancer multidisciplinary team working and national advisory panels in the UK: a qualitative research study. Arch Dis Child 2024; 109:321-325. [PMID: 38290777 DOI: 10.1136/archdischild-2023-326604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The concept of patient-centred care is central to the role of cancer multidisciplinary teams (MDTs) and particularly pertinent with the recent rise in number of virtual national advisory panels (NAPs) for childhood cancer in the UK. We sought to explore patient and caregiver views regarding MDT working and NAPs. METHODS Three focus groups were undertaken between March 2019 and January 2020. RESULTS Sixteen participants attended. All regarded MDTs and NAPs highly, while highlighting patient involvement in decision-making should not be diluted by this process. The importance of personalised consultations was stressed, acknowledging that information-sharing preferences may change with circumstance and time. Most participants felt they had not been actively involved in decisions, including those made following MDT or NAP discussions. Group suggestions to improve patient-centred care included a clinician knowing them presenting their case, referral proformas to include family-related factors and an advocate attending meetings to represent the patient/family view. CONCLUSION Several changes have been driven forward by this work, including the modification of NAP referral proformas to include additional information. Patient and parent perspectives are now embedded into a best practice model for the NAPs to promote personalised recommendations at national level.
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Affiliation(s)
- Sarah Brown
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - Katie Johnson
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - Jessica Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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Rajadevan N, Flinkier A, Saunders H, Lee YC, Scott C, Khaw P, Allan P, Davies C, Andrews J, Wilson M, Lombard JM, Harrison M, Nesfield H, DeFazio A, Meniawy T, Gorringe KL. Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2024. [PMID: 38299485 DOI: 10.1111/ajo.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care. AIMS We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities. METHODS A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality. RESULTS Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with 'Is a GI chemotherapy regimen better than an ovarian regimen?' the most highly ranked option, followed by 'Should stage 1C patients receive chemotherapy?' CONCLUSIONS Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.
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Affiliation(s)
- Niveditha Rajadevan
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Ariane Flinkier
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Hugo Saunders
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Yeh Chen Lee
- Prince of Wales Hospital and Royal Hospital for Women, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Clare Scott
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Pearly Khaw
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Prue Allan
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Claire Davies
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - John Andrews
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - Michelle Wilson
- Auckland City Hospital and The University of Auckland, Auckland, New Zealand
| | | | | | - Heshani Nesfield
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - Anna DeFazio
- The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Tarek Meniawy
- St John of God Hospital and University of Western Australia, Perth, Western Australia, Australia
| | - Kylie L Gorringe
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Abdul Rehman M, Naeem U, Rani A, Banatwala UESS, Salman A, Abdullah Khalid M, Ikram A, Tahir E. How well does the virtual format of oncology multidisciplinary team meetings work? An assessment of participants' perspectives and limitations: A scoping review. PLoS One 2023; 18:e0294635. [PMID: 37972143 PMCID: PMC10653537 DOI: 10.1371/journal.pone.0294635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Virtual multidisciplinary team meetings (VMDTM) provide a standard of care that is not limited by physical distance or social restrictions. And so, when the COVID-19 pandemic imposed irrefutable social restrictions and made in-person meetings impossible, many hospitals switched to the VMDTMs. Although the pandemic might have highlighted the ease of VMDTMs, these virtual meetings have existed over the past decade, albeit less in importance. Despite their recent importance, no review has previously assessed the feasibility of VMDTMs through the eyes of the participants, the barriers participants face, nor their comparison with the in-person format. We undertook this scoping review to map existing literature and assess the perspectives of VMDTM participants. MATERIAL AND METHODS We searched MEDLINE, Embase, CINAHL, and Google Scholar from inception till July 1st, 2023 to select studies that evaluated the perspectives of participants of VMDTMs regarding the core components that make up a VMDMT. Four authors, independently, extracted data from all included studies. Two authors separated data into major themes and sub-themes. RESULTS We identified six core, intrinsic aspects of a VMDTM that are essential to its structure: (1) organization, (2) case discussion and decision-making, (3) teamwork and communication, (4) training and education, (5) technology, and (6) patient-related aspect. VMDTMs have a high overall satisfaction rating amongst participants. The preference, however, is for a hybrid model of multidisciplinary teams. VMDTMs offer support to isolated physicians, help address complex cases, and offer information that may not be available elsewhere. The periodical nature of VMDTMs is appropriate for their consideration as CMEs. Adequate technology is paramount to the sustenance of the format. CONCLUSION VMDTMs are efficient and offer a multidisciplinary consensus without geographical limitations. Despite certain technical and social limitations, VMDTM participants are highly satisfied with the format, although the preference lies with a hybrid model.
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Affiliation(s)
- Muhammad Abdul Rehman
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Unaiza Naeem
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Anooja Rani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Afia Salman
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Abdullah Khalid
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Ikram
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Erfa Tahir
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
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Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
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Brown S, Chowdhury T, Collin M, Grundy RG, Howell L, Ramanujachar R, Rees H, Vora A, Gray JC, Bate J. National advisory panels for childhood cancer in the United Kingdom: An evaluation of current practice and a best practice statement for the future. Pediatr Blood Cancer 2023; 70:e30159. [PMID: 36565277 DOI: 10.1002/pbc.30159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND National advisory panels (NAPs) have been established for the care of children and young people (CYP) with cancer in the United Kingdom since 2011, with an increase in panel number in recent years. Their practice has not previously been reviewed; therefore, we sought to evaluate the role, practice and impact of six selected NAPs offering expertise in ependymoma, histiocytosis, leukaemia, neuroblastoma, renal tumours and sarcoma. PROCEDURE This service evaluation used mixed methodology, including review of NAP documentation, semi-structured interviews with the NAP chairs and an analysis of the cases referred for discussion. RESULTS Total 1110 referrals were analysed. Results demonstrated the significant scope and amount of work undertaken by the NAPs, largely testament to the commitment of the panel members. Specific roles fulfilled have been highlighted, and NAP recommendations have been shown to influence clinical decision-making and be implemented in the majority of cases. Despite widespread good practice, areas to address have been identified; these include clarity regarding NAP membership, consistency in recommendations, the consideration of holistic information to promote personalised management and the exploration of wider multidisciplinary team roles. CONCLUSIONS In the context of increasing demand and the escalating number of NAPs, it is timely to consider how service improvement can be facilitated. Best practice guidelines have been formulated as a product of this study, to promote a sustainable and effective model for NAPs. Review and benchmarking national panel performance against these guidelines will drive high standards of care going forward and they should be embedded as standard practice.
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Affiliation(s)
- Sarah Brown
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK.,Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Tanzina Chowdhury
- Department of Paediatric Oncology, Great Ormond Street Hospital, London, UK
| | - Matthew Collin
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, Bio-Discovery Institute and Queen's Medical Centre, University Hospital Nottingham, Nottingham, UK
| | - Lisa Howell
- Department of Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ramya Ramanujachar
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Helen Rees
- Department of Paediatric Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Juliet C Gray
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK.,Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Jessica Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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Papermaster AE, Whitney M, Vinas EK. Interprofessional Case Conference Enhances Group Learning and the Quality, Safety, Value, and Equity of Team-Based Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:4-11. [PMID: 36849427 DOI: 10.1097/ceh.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/07/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice. METHODS Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test. RESULTS Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient's first follow-up and last visits. CONCLUSION Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.
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Affiliation(s)
- Amy E Papermaster
- Dr. Papermaster: Assistant Professor, School of Nursing, The University of Texas at Austin, Austin, TX, and Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Dr. Whitney: Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Ms. Vinas: Assistant Professor and Associate Chair of Education, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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Rosell L, Melander W, Lindahl B, Nilbert M, Malmström M. Registered nurses' views on consideration of patient perspectives during multidisciplinary team meetings in cancer care. BMC Nurs 2022; 21:350. [PMID: 36494850 PMCID: PMC9732978 DOI: 10.1186/s12912-022-01127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs) represent an integral component of modern cancer care and have increasingly been implemented to ensure accurate and evidence-based treatment recommendations. During MDTMs, multiple and complex medical and patient-related information should be considered by a multi-professional team whose members contribute various perspectives. Registered nurses (RNs) are expected to share information on the patient perspective at MDTMs. However, research suggests that RNs' contributions to case discussions are limited and that patient perspective is generally underrepresented. Our aim was to explore RNs' views of the prerequisites for and barriers to the inclusion of the patient perspective in MDTMs in Swedish cancer care. METHODS Data were collected from four focus group interviews with 22 RNs who worked as contact nurses in Swedish cancer care. Interviews were transcribed and analysed using inductive content analysis. RESULTS The analysis identified two categories and five subcategories. The participants presented different views and expressed ambivalence about the patient perspective in MDTMs. Subcategories were related to medical versus holistic perspectives, the added value of patient perspective, and possibilities for patient contributions. The participants also discussed prerequisites for the patient perspective to be considered in MDTM decision-making process, with subcategories related to structures promoting attention to the patient perspective and determinants of RNs' contributions to case discussions in MDTMs. CONCLUSIONS This study demonstrates various views related to the patient perspective in MDTMs and identifies a great need to clarify the RN's role. Our results indicate that if enhanced presentation of the patient perspective in MDTMs is desired, key information points and structures must be established to collect and present relevant patient-related information.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Wenche Melander
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Berit Lindahl
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.4514.40000 0001 0930 2361Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Mef Nilbert
- grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Marlene Malmström
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
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Douglas N, Mays N, Al-Haboubi M, Manacorda T, Thana L, Wistow G, Durand MA. Observations of community-based multidisciplinary team meetings in health and social care for older people with long term conditions in England. BMC Health Serv Res 2022; 22:758. [PMID: 35676685 PMCID: PMC9175164 DOI: 10.1186/s12913-022-07971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background Community-based multi-disciplinary teams (MDTs) are the most common means to encourage health and social care service integration in England yet are rarely studied or directly observed. This paper reports on two rounds of non-participant observations of community-based multi-disciplinary team (MDT) meetings in two localities, as part of an evaluation of the Integrated Care and Support Pioneers Programme. We sought to understand how MDT meetings coordinate care and identify their ‘added value’ over bilateral discussions. Methods Two rounds of structured non-participant observations of 11 MDTs (28 meetings) in an inner city and mixed urban–rural area in England (June 2019-February 2020), using a group analysis approach. Results Despite diverse settings, attendance and caseloads, MDTs adopted similar processes of case management: presentation; information seeking/sharing; narrative construction; solution seeking; decision-making and task allocation. Patient-centredness was evident but scope to strengthen ‘patient-voice’ exists. MDTs were hampered by information governance rules and lack of interoperability between patient databases. Meetings were characterised by mutual respect and collegiality with little challenge. Decision-making appeared non-hierarchical, often involving dyads or triads of professionals. ‘Added value’ lay in: rapid patient information sharing; better understanding of contributing agencies’ services; planning strategies for patients that providers had struggled to find the right way to engage satisfactorily; and managing risk and providing mutual support in stressful cases. Conclusions More attention needs to be given to removing barriers to information sharing, creating scope for constructive challenge between staff and deciding when to remove cases from the caseload.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07971-x.
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Affiliation(s)
- Nick Douglas
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK. .,Now School of Psychology, University of Sussex, Brighton, East Sussex, UK.
| | - Nicholas Mays
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mustafa Al-Haboubi
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tommaso Manacorda
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Now Public Health, Advocacy and Welfare, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Lavanya Thana
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerald Wistow
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Care Policy & Evaluation Centre, London School of Economics & Political Science, London, UK
| | - Mary Alison Durand
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Zinterl C, Costa-Reis P, Esteves IC, Marques JG, Sousa AB, Fonseca JE, Oliveira Ramos F. The Added Value of a Multidisciplinary Clinic for Systemic Autoinflammatory Diseases. J Multidiscip Healthc 2022; 15:999-1010. [PMID: 35548670 PMCID: PMC9081005 DOI: 10.2147/jmdh.s351546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carolina Zinterl
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Correspondence: Carolina Zinterl, Serviço de Reumatologia, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, EPE, R. Prof. Egas Moniz, Lisboa, 1700, Portugal, Tel +351 217805139, Email
| | - Patrícia Costa-Reis
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Isabel Castro Esteves
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - José Gonçalo Marques
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana Berta Sousa
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Department of Basic Immunology, Faculty of Medicine, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira Ramos
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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11
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Remon J, Bernabé R, Diz P, Felip E, González-Larriba JL, Lázaro M, Mielgo-Rubio X, Sánchez A, Sullivan I, Massutti B. SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021). Clin Transl Oncol 2022; 24:635-645. [PMID: 35122634 PMCID: PMC8817662 DOI: 10.1007/s12094-022-02788-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.
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Affiliation(s)
- J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Nou Delfos, HM Hospitales, Avinguda de Vallcarca, 151, 08023, Barcelona, Spain.
| | - R Bernabé
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - P Diz
- Department of Medical Oncology, Hospital Universitario de León, León, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J L González-Larriba
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - M Lázaro
- Department of Medical Oncology, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - X Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Sánchez
- Department of Medical Oncology, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - I Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - B Massutti
- Department of Medical Oncology, Hospital General Universitario de Alicante, Alicante, Spain
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12
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Tran TH, de Boer J, Gyorki DE, Krishnasamy M. Optimising the quality of multidisciplinary team meetings: A narrative review. Cancer Med 2022; 11:1965-1971. [PMID: 35257515 PMCID: PMC9089217 DOI: 10.1002/cam4.4432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/08/2022] Open
Abstract
Background Understanding of factors that contribute to implementation of effective cancer multidisciplinary team meetings (MDMs) is still limited. Published literature on the effect of teamwork function, leadership roles, decision‐making processes and structural components on the quality of MDMs was reviewed and synthesised. Methods In this paper, a MEDLINE review (September 2020) was performed to assess clinical decision‐making in the context of MDM discussions. Results Twenty‐nine eligible studies were included. Six studies addressed the infrastructural aspects of MDMs. Nine studies used either qualitative or mixed method approach to develop and validate observational tools to assess the quality of MDMs. Seven studies used qualitative approaches to explore the opinions of MDM members on factors that impact on the effectiveness of MDMs. Five studies used validated observational tools to observe and assess the effectiveness of MDMs. One prospective study explored the relationship between quality of information presented at MDMs and ability of MDM members to make clinical decisions. The final study prospectively tested the ability of a multicomponent intervention to improve decision‐making processes within MDMs. Conclusions A broad range of factors including teamwork, leadership, case complexity, decision‐making processes and availability of patient information were identified to impact the quality of MDMs. Evidence currently available largely focuses on the development of tools to identify factors in need of improvement to optimise MDMs. Robust research is required to identify the factors that are demonstrated to enhance MDM quality which can then aid the standardisation of how MDMs are conducted.
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Affiliation(s)
- Thanh Hai Tran
- University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jasper de Boer
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - David E Gyorki
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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13
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Perlmutter B, Said SAD, Hossain MS, Simon R, Joyce D, Walsh RM, Augustin T. Lessons learned and keys to success: Provider experiences during the implementation of virtual oncology tumor boards in the era of COVID-19. J Surg Oncol 2022; 125:570-576. [PMID: 34994401 PMCID: PMC9015483 DOI: 10.1002/jso.26784] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
Background and Objectives The COVID‐19 pandemic required rapid adaptation of multidisciplinary tumor board conferences to a virtual setting; however, there are little data describing the benefits and challenges of using such a platform. Methods An anonymous quality improvement survey was sent to participants of tumor board meetings at a large academic institution. Participants answered questions pertaining to the relative strengths and weaknesses of in‐person and virtual settings. Results A total of 335 responses (23.3% response rate) were recorded, and 253 met inclusion criteria. Respondents represented 25 different tumor board meetings, with colorectal, breast, and liver (18.6%, 17.0%, and 13.0%, respectively) being the most commonly attended. Virtual tumor boards were equivalent to in‐person across 9 of 10 domains queried, while a virtual format was preferred for participation in off‐site tumor boards. The lack of networking opportunities was ranked by physicians to be a significant challenge of the virtual format. Consistent leadership and organization, engaged participation of all attendees, and upgrading technology infrastructure were considered critical for success of virtual meetings. Conclusions The implementation of virtual tumor board meetings has been associated with numerous challenges. However, improving several key aspects can improve participant satisfaction and ensure excellent patient care.
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Affiliation(s)
| | - Sayf Al-Deen Said
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Robert Simon
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Joyce
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toms Augustin
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Bandini M, Ahmed M, Basile G, Watkin N, Master V, Zhu Y, Prakash G, Rodriguez A, Ssebakumba MK, Leni R, Cirulli GO, Ayres B, Compitello R, Pederzoli F, Joshi PM, Kulkarni SB, Montorsi F, Sonpavde G, Necchi A, Spiess PE. A global approach to improving penile cancer care. Nat Rev Urol 2022; 19:231-239. [PMID: 34937881 PMCID: PMC8693593 DOI: 10.1038/s41585-021-00557-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
Rare tumours such as penile carcinoma have been largely neglected by the urology scientific community in favour of more common - and, therefore, more easily fundable - diseases. Nevertheless, penile cancer represents a rising burden for health-care systems around the world, because a lack of widespread expertise, ineffective centralization of care and absence of research funds have hampered our ability to improve the global care of these patients. Moreover, a dichotomy has arisen in the field of penile cancer, further impeding care: the countries that are mainly supporting research on this topic through the development of epidemiological studies and design of clinical trials are not the countries that have the highest prevalence of the disease. This situation means that randomized controlled trials in developed countries often do not meet the minimum accrual and are intended to close before reaching their end points, whereas trials are almost completely absent in those areas with the highest disease prevalence and probability of successful recruitment, such as Africa, South America and South Asia. The scientific and organizational inaction that arises owing to this mismatch translates into a burdensome cost for our patients. A global effort to gather experts and pull together scientific data from around the world may be the best way to boost clinical research, to change clinical practice and, ultimately, to improve care for patients and their families.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Mohamed Ahmed
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA
| | - Giuseppe Basile
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Watkin
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Viraj Master
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Department of Urology, Atlanta, GA USA
| | - Yao Zhu
- grid.452404.30000 0004 1808 0942Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gagan Prakash
- grid.450257.10000 0004 1775 9822Department of Urosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Alejandro Rodriguez
- grid.416016.40000 0004 0456 3003Urology Associates of Rochester, Rochester General Hospital, Rochester, NY USA
| | | | - Riccardo Leni
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ben Ayres
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Rachel Compitello
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Filippo Pederzoli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Pankaj M. Joshi
- grid.512719.9Kulkarni Reconstructive Urology Center, Pune, India
| | | | - Francesco Montorsi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Guru Sonpavde
- grid.38142.3c000000041936754XDana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Andrea Necchi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E. Spiess
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
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15
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van Huizen LS, Dijkstra PU, van der Werf S, Ahaus K, Roodenburg JL. Benefits and drawbacks of videoconferencing for collaborating multidisciplinary teams in regional oncology networks: a scoping review. BMJ Open 2021; 11:e050139. [PMID: 34887273 PMCID: PMC8662582 DOI: 10.1136/bmjopen-2021-050139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Various forms of videoconferenced collaborations exist in oncology care. In regional oncology networks, multidisciplinary teams (MDTs) are essential in coordinating care in their region. There is no recent overview of the benefits and drawbacks of videoconferenced collaborations in oncology care networks. This scoping review presents an overview of videoconferencing (VC) in oncology care and summarises its benefits and drawbacks regarding decision-making and care coordination. DESIGN We searched MEDLINE, Embase, CINAHL (nursing and allied health) and the Cochrane Library from inception to October 2020 for studies that included VC use in discussing treatment plans and coordinating care in oncology networks between teams at different sites. Two reviewers performed data extraction and thematic analyses. RESULTS Fifty studies were included. Six types of collaboration between teams using VC in oncology care were distinguished, ranging from MDTs collaborating with similar teams or with national or international experts to interactions between palliative care nurses and experts in that field. Patient benefits were less travel for diagnosis, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals were optimised treatment plans through multidisciplinary discussion of complex cases, an ability to inform all healthcare professionals simultaneously, enhanced care coordination, less travel and continued medical education. VC added to the regular workload in preparing for discussions and increased administrative preparation. DISCUSSION Benefits and drawbacks for collaborating teams were tied to general VC use. VC enabled better use of staff time and reduced the time spent travelling. VC equipment costs and lack of reimbursement were implementation barriers. CONCLUSION VC is highly useful for various types of collaboration in oncology networks and improves decision-making over treatment plans and care coordination, with substantial benefits for patients and specialists. Drawbacks are additional time related to administrative preparation.
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Affiliation(s)
- Lidia S van Huizen
- Quality and Safety, University Medical Centre Groningen, Groningen, The Netherlands
- Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Center for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sjoukje van der Werf
- Central Medical Library, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy and Management, Department of Health Services Management and Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Ln Roodenburg
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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16
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Remon J, Hendriks LEL, Bironzo P. Malignant pleural mesothelioma: new guidelines make us stronger for defeating this disease. Ann Oncol 2021; 33:123-125. [PMID: 34883215 DOI: 10.1016/j.annonc.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Nou Delfos, HM Hospitales, Barcelona, Spain.
| | - L E L Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - P Bironzo
- Department of Oncology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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17
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Brown S, Bate J. National advisory panels for paediatric cancer in the UK as an example of rare cancer multidisciplinary team meetings. Rare Tumors 2021; 13:20363613211052503. [PMID: 34733447 PMCID: PMC8559199 DOI: 10.1177/20363613211052503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- S Brown
- Department of Paediatric Oncology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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18
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Centralization and Equitable Care in Rare Urogenital Malignancies: The Case for Penile Cancer. Eur Urol Focus 2021; 7:924-928. [PMID: 34593356 DOI: 10.1016/j.euf.2021.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Centralization of specialized care for rare cancers can improve patient outcomes. Inguinal lymph node evaluation is the most important clinical aspect of penile cancer care and is often neglected in a decentralized setting. Centralization of care may reduce system delays, improve guideline adherence, provide access to a wider team of specialists, and improve prognosis, albeit with some inconveniences for patients. PATIENT SUMMARY: We reviewed evidence for the centralization of care for penile cancer. Patients may have to travel greater distances to receive specialized care in expert centers. However, centralization means that rare cancers can be treated by more experienced surgeons, which can yield better outcomes in terms of survival and penis-preserving or reconstruction surgery.
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19
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Wihl J, Rosell L, Frederiksen K, Kinhult S, Lindell G, Nilbert M. Contributions to Multidisciplinary Team Meetings in Cancer Care: Predictors of Complete Case Information and Comprehensive Case Discussions. J Multidiscip Healthc 2021; 14:2445-2452. [PMID: 34511928 PMCID: PMC8426643 DOI: 10.2147/jmdh.s309162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Multidisciplinary team (MDT) meetings integrate complex information and base recommendations for clinical management on interdisciplinary and multiprofessional decision-making. To support high-quality decision-making and define key performance indicators, we aimed to determine completeness of case information and contributions to MDT case discussions in cancer care. Methods In a prospective observational study design, based on three MDTs, we applied the Metric for Observation of Decision-Making (MODe) tool to assess the quality of case presentation and team members’ contributions to case discussions. The MDTs handled patients with brain tumors, soft tissue sarcomas and hepatobiliary cancers. The results were correlated to patient and team characteristics and to MDT leadership skills. Results Data were collected from 349 case discussions during 32 MDT meetings. Information on radiology received the highest scores, followed by case history and information on histopathology. Patient-related information was less frequently mentioned and generally received low scores. Contributions to the case discussions were predominantly by the chair, surgeons, and oncologists with limited contributions from nurses. Leadership skills showed a positive correlation with case presentations scores and failure to reach a treatment recommendation correlated with lower case discussion scores. Conclusion Considerable resources are spent on MDT meetings in cancer care, which motivate initiatives to ensure high-quality and efficient decision-making processes. We identify unbalanced contributions from team members during MDT meetings, demonstrate limited provision of patient-related information and show that leadership skills may positively influence the quality of the case presentations. We suggest that MDTs should consider and develop these aspects to ensure high-quality MDT-based case management and decision-making.
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Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Linn Rosell
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | | | - Sara Kinhult
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Danish Cancer Society Research Centre, Copenhagen, Denmark.,Clinical Research Centre, Hvidovre University Hospital and Copenhagen University, Copenhagen, Denmark
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20
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Khiat S, Pibarot M, Roux J, Bottin P, Saïas J, Rives N, Courbiere B. Challenging cases in oncofertility: insights from a national specialized e-meeting for fertility preservation specialists. J Assist Reprod Genet 2021; 38:2445-2453. [PMID: 34291419 PMCID: PMC8294278 DOI: 10.1007/s10815-021-02275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To determine the use of a new specialized E-Meeting for Complex Cases in Oncofertility by fertility preservation specialists (FPSs) Material and methods We present 3 years of activity of the E-Meeting for Complex Cases in Oncofertility, a new tool created in September 2016 which allows national oncofertility experts to share viewpoints about challenging cases for which they do not have experience or sufficient data in order to provide them an emergency advice within 48 h. Second, a survey was conducted to evaluate the use of this e-meeting for participating FPSs. Results One hundred and four experts have joined the e-meeting since its set-up, and 109 challenging cases have been submitted. The mean age of the patients was 22.4 ± 8.9 years, and 87.0% were female. Each submitted case received on average of 1.8 ± 1.1 different strategies for FP and the opinions of 7.1 ± 3.4 experts. Among the FPSs who submitted cases, seeking opinions from other FPSs allowed them to confirm their care plan (N = 49, 84.4%), to offer different options to their patients (N = 34, 58.6%), and to compare their practices with those of other specialists (N = 23, 39.6%). All respondents reported a self-perceived improvement in their practice of oncologic FP (n = 80, 100.0%). Conclusion Specific attention should be paid to challenging cases for which the experiences of only a few individuals exist. Enhancing communication between FPSs through oncofertility networks, pooling experiences, and collecting the most complex cases is required to improve the management of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02275-1.
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Affiliation(s)
- Samuel Khiat
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Michele Pibarot
- Regional Network of Cancerology ONCOPACA-Corse, hôpitaux Sud, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Jennifer Roux
- Regional Network of Cancerology ONCOPACA-Corse, hôpitaux Sud, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Pauline Bottin
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Jacqueline Saïas
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Nathalie Rives
- Biology of Reproduction-CECOS Laboratory, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Normandie Univ, 76031, Rouen, France
| | - Blandine Courbiere
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France. .,CNRS, IRD, Avignon Université, IMBE, Aix Marseille Univ, 13397, Marseille, France.
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21
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Blasi L, Bordonaro R, Serretta V, Piazza D, Firenze A, Gebbia V. Virtual Clinical and Precision Medicine Tumor Boards, a Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era: an Observational Study Protocol. JMIR Res Protoc 2021; 10:e26220. [PMID: 34387553 PMCID: PMC8437400 DOI: 10.2196/26220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patient satisfaction. Methods This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study’s programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives’ measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID) DERR1-10.2196/26220
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Affiliation(s)
| | | | | | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, IT
| | | | - Vittorio Gebbia
- La Maddalena Cancer Center, via San Lorenzo Colli n. 312d, 90100, Palermo, Italy, palermo, IT
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22
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Lamb BW, Miah S, Skolarus TA, Stewart GD, Green JSA, Sevdalis N, Soukup T. Development and Validation of a Short Version of the Metric for the Observation of Decision-Making in Multidisciplinary Tumor Boards: MODe-Lite. Ann Surg Oncol 2021; 28:7577-7588. [PMID: 33974197 PMCID: PMC8519835 DOI: 10.1245/s10434-021-09989-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
Background Evidence-based tools are necessary for scientifically improving the way MTBs work. Such tools are available but can be difficult to use. This study aimed to develop a robust observational assessment tool for use on cancer multidisciplinary tumor boards (MTBs) by health care professionals in everyday practice. Methods A retrospective cross-sectional observational study was conducted in the United Kingdom from September 2015 to July 2016. Three tumor boards from three teaching hospitals were recruited, with 44 members overall. Six weekly meetings involving 146 consecutive cases were video-recorded and scored using the validated MODe tool. Data were subjected to reliability and validity analysis in the current study to develop a shorter version of the MODe. Results Phase 1, a reduction of the original items in the MODe, was achieved through two focus group meetings with expert assessors based on previous research. The 12 original items were reduced to 6 domains, receiving full agreement by the assessors. In phase 2, the six domains were subjected to item reliability, convergent validation, and internal consistency testing against the MODe-Lite global score, the MODe global score, and the items of the MODe. Significant positive correlations were evident across all domains (p < 0.01), indicating good reliability and validity. In phase 3, feasibility and high inter-assessor reliability were achieved by two clinical assessors. Six domains measuring clinical input, holistic input, clinical collaboration, pathology, radiology, and management plan were integrated into MODe-Lite. Conclusions As an evidence-based tool for health care professionals in everyday practice, MODe-Lite gives cancer MTBs insight into the way they work and facilitates improvements in practice. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-09989-7.
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Affiliation(s)
- B W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - S Miah
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - T A Skolarus
- VA Health Service Research and Development Center for Clinical Management Research, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - G D Stewart
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - J S A Green
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.,Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - N Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - T Soukup
- Center for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.
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23
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Leal I, Romão VC, Mano S, Khmelinskii N, Campanilho-Marques R, Ponte C, Macieira C, Oliveira-Ramos F, Vieira-Sousa E, Rosa CM, Rodrigues W, Abegão Pinto L, Marques-Neves C, Fonseca JE. A Non-Infectious Uveitis Multidisciplinary Clinic in a Tertiary Referral Center: Clinical Impact and Added Value. J Multidiscip Healthc 2021; 14:695-704. [PMID: 33790568 PMCID: PMC7997415 DOI: 10.2147/jmdh.s292981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Non-infectious uveitis (NIU) is a group of sight-threatening diseases that generates significant burden for the healthcare systems due to its adverse outcomes, irreversible structural complications in the eye with loss of visual function, limited clinical expertise and low-grade evidence for best practice. The usefulness of multidisciplinary care, specifically close collaboration between Rheumatologists and Ophthalmologists in NIU, has been emphasized in the literature. In this paper, the assessment tools and protocols used in our clinic are depicted and an overview of our activity with a brief description of the patients included in our registry, between 2018 and 2020 is provided. The cohort of 290 patients assessed in our NIU clinic, their demographics, sources of referral, details about immunosuppression treatment, and internal and external collaborations is described. This experience-based manuscript aims to describe the general functioning of our multidisciplinary NIU clinic, highlighting the benefits and drawbacks of multidisciplinary team management in patients with NIU, ultimately initiating a dialogue on what an NIU clinic should be and providing information for newly NIU clinics start-up. In conclusion, establishing a standardized and multidisciplinary clinic in NIU allows to systematically observe and follow-up this infrequent disease at a tertiary hospital level, thus improving quality of care delivery and research avenues.
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Affiliation(s)
- Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Mano
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Raquel Campanilho-Marques
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira-Ramos
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Miranda Rosa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Walter Rodrigues
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Luís Abegão Pinto
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Marques-Neves
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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24
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Nilbert M, Thomsen LA, Winther Jensen J, Møller H, Borre M, Widenlou Nordmark A, Lambe M, Brändström H, Kørner H, Møller B, Ursin G. The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care. Acta Oncol 2020; 59:1343-1356. [PMID: 32981417 DOI: 10.1080/0284186x.2020.1820573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Scandinavia, there is a strong tradition for research and quality monitoring based on registry data. In Denmark, Norway and Sweden, 63 clinical registries collect data on disease characteristics, treatment and outcome of various cancer diagnoses and groups based on process-related and outcome-related variables. AIM We describe the cancer-related clinical registries, compare organizational structures and quality indicators and provide examples of how these registries have been used to monitor clinical performance, develop prediction models, assess outcome and provide quality benchmarks. Further, we define unmet needs such as inclusion of patient-reported outcome variables, harmonization of variables and barriers for data sharing. RESULTS AND CONCLUSIONS The clinical registry framework provides an empirical basis for evidence-based development of high-quality and equitable cancer care. The registries can be used to follow implementation of new treatment principles and monitor patterns of care across geographical areas and patient groups. At the same time, the lessons learnt suggest that further developments and coordination are needed to utilize the full potential of the registry initiative in cancer care.
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Affiliation(s)
- Mef Nilbert
- Department of Oncology, Lund University, Lund, Sweden
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Clinical Research Department, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Jens Winther Jensen
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Michael Borre
- The Association of Danish Multidisciplinary Cancer Groups, Aarhus, Denmark
| | | | - Mats Lambe
- The Federation of Regional Cancer Centers, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Hartwig Kørner
- Institute of Surgical Sciences, University of Bergen, Bergen, Norway
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25
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Rosell L, Wihl J, Nilbert M, Malmström M. Health Professionals' Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study. J Multidiscip Healthc 2020; 13:179-186. [PMID: 32103978 PMCID: PMC7029585 DOI: 10.2147/jmdh.s240140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Multidisciplinary team meetings (MDTMs) are an integral component of cancer care. Increasingly, virtual MDTMs are used to grant high-quality treatment recommendations across health-care regions, which expands and develops the local MDTM team to a regional or national expert network. We investigated health professionals' experiences from national, virtual MDTMs for rare cancer with a focus on key enabling factors and barriers. Methods Health professionals who participate in seven national, virtual MDTMs in Swedish health-care responded to a questionnaire exploring key enabling factors, barriers and opportunities for MDTM development. Conventional content analysis was used to identify thematic categories based on free-text responses. Results Participants´ perspectives could be assigned into three categories ie, a national arena with potential for comprehensive knowledge and collaboration, prerequisites for decision-making and organization and responsibilities. These categories consisted of nine sub-categories that referred to, eg, collective competence, resources, clinical research, case discussion, meeting climate, patient-related information, MDTMs potential, referral and technical insufficiencies. Conclusion National, virtual MDTMs represent a new multidisciplinary collaborative arena that introduces benefits as well as challenges. Consideration of key enabling factors and barriers may ease implementation and further optimize MDTMs in cancer care.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden
| | - Jessica Wihl
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark.,Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Marlene Malmström
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Health Sciences, Lund, Sweden
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