Influence of endocrine multidisciplinary tumor board on patient management and treatment decision making

Author(s):  
Sarah Kelley ◽  
Anna C. Beck ◽  
Ronald J. Weigel ◽  
James R. Howe ◽  
Sonia L. Sugg ◽  
...  
2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23015-e23015
Author(s):  
Barbara Oureilidis-DeVivo

e23015 Background: Interdisciplinary teams are an indispensable characteristic of modern organizations, particularly in healthcare settings that require specialists to work together to solve multifaceted patient care problems. Multidisciplinary tumor boards (TBs) aim to coordinate multidisciplinary perspectives to help the oncology team devise the best treatment program for the patient. Yet, while this is their purpose, studies have found that TBs do not always achieve that goal effectively. Why are some tumor board (TB) teams more effective than others? This study shed light on key characteristics found among highly effective TBs. It provides a theoretical explanation of their organizational behaviors and structures and their effect on cancer treatment decision-making. The research is grounded in organizational behavior theories that have historical prominence in group decision-making, social hierarchy, and interdisciplinary collaboration, and are used to explain the phenomenon under investigation best. Methods: Qualitative research was used in the study. Data from 44 different TB observations and 18 interviews were gathered over four years at seven research hospitals in the United States and United Kingdom. The data were then coded, analyzed and synthesized with organizational behavior theory to explain the social phenomena under investigation. Results: The study revealed that certain TBs practice strong collaboration displaying high levels of partnership, cooperation, equality, and interdependency, which was incorporated explicitly into their meeting systems to achieve their common goal. Team-based characteristics such as members’ consistent shared preferences and identity, coordinated interactions, a collective learning process, and shared power and partnership are key markers found within these teams that positively influenced treatment decision-making processes and outcomes, earmarking best practices in TB groups. Conclusions: Organizational theory that suggests that for a collaborative process to be effective, team-based mechanisms need to be adopted in which each member respects, trusts, and acknowledges the skills and expertise of other disciplines in the organization, shares team values, decision-making processes, responsibilities, and planning, relies mutually upon other team members, and works outside normal professional boundaries openly and willingly. In an egalitarian structure like that of the TBs reviewed in this study, where preferences and identities are consistent and groups are collaborative, treatment decisions are less biased and incorporate multidisciplinary perspectives. Thus, this study suggests that by possessing both team- and task-based characteristics and practices, TBs engage in best practices, and thereby optimize their functionality.


2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 112-112
Author(s):  
Henner M. Schmidt ◽  
John M. Roberts ◽  
Artur M. Bodnar ◽  
Steven H. Kirtland ◽  
Sonia H. Kunz ◽  
...  

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures. Major changes were defined as changes to final therapeutic plans such as surgery, chemotherapy, or radiation therapy. Results: 435 patients with esophageal or lung cancer were discussed in the MTB. 86 patients having no prior treatment plan available were excluded. In the remaining 347 patients there were 163 patients with esophageal cancer (47%) and 184 patients with lung cancer (53%). In the esophageal cancer patients a change to the physician’s prior treatment plan was recommended in 33 cases (21%). For lung cancer patients a change in the treatment plan was recommended in 50 cases (27%). Overall a recommendation for change in treatment occurred in 83 cases (24 %). Changes were major 13%, moderate 6% and minor 5%. Follow-up in 249 patients confirmed that MTB recommendations were followed in 97% of cases. Conclusions: MTB recommendations frequently differs from the physician’s primary treatment plan. MTB reviews have previously been documented to improve patient’s outcome. The study demonstrates that in one quarter of patients MTB recommendation will be different from the primary treatment plan. Complex cancer patients should be considered for presentation at MTB whenever feasible.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18329-e18329
Author(s):  
Kyounga Lee ◽  
Seon Heui Lee ◽  
Anita Preininger ◽  
JungHo Shim ◽  
Gretchen Jackson

e18329 Background: Watson For Oncology (WFO) is an artificial intelligence (AI) tool that presents therapeutic options to oncologists and patients at 9 hospitals in Korea. The earliest user is Gachon University Gil Medical Center (GMC), where the tumor board (MDT) is fully integrated with WfO (MDT-WfO). GMC patients and oncologists may select one of the treatment choices presented by MDT-WfO or choose to follow recommendations of one or more oncologists at GMC augmented by WfO (non-MDT-WfO). This study is aimed at determining the satisfaction of patients who pursue shared decision-making through the MDT-WfO approach. Methods: Cancer patients enrolled in this IRB-approved study and treated at GMC between March and September of 2018 were surveyed. All patients rated satisfaction levels from 1-10 after treatment decision-making was completed, with 1 indicating the lowest level of satisfaction and 10 the highest. For each question, the average satisfaction score for patients in the MDT-WfO group was compared to the mean for patients in the non-MDT-WfO group, with a t-test for significance. Results: There were 9 cancer types treated at GMC from March through September of 2018. Of the of 290 patients enrolled in this study, 130 (44.8%) selected MDT-WfO and 160 (55.2%) did not. Overall, patients that interacted with MDT-WfO viewed GMT more positively (86.9%) after treatment decisions had been made than patients in the non-MDT-WfO group (71.3%).Although patients did not report significantly differing levels of satisfaction for most survey questions, there was a significant difference in terms of satisfaction with the explanation they received from the medical staff. Satisfaction level for this item was 9.52 with MDT-WfO and 9.22 points without ( p = 0.029). Conclusions: Patients reported greater satisfaction in the explanations they received in the MDT-WfO group, consistent with their more positive impression of GMT after treatment decisions were made. More studies are needed to determine if the increase in the level of satisfaction for this item is due to explanations from MDT unrelated or related to WfO. More studies on how WfO is used differently by the tumor board and individual oncologists may provide a unique perspective on how WfO is integrated into the MDT.


2017 ◽  
Vol 13 (2) ◽  
pp. 169-184 ◽  
Author(s):  
Shuya Kushida ◽  
Takeshi Hiramoto ◽  
Yuriko Yamakawa

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.


2007 ◽  
Author(s):  
Mary A. O'Brien ◽  
Timothy Whelan ◽  
Amiram Gafni ◽  
Cathy Charles ◽  
Peter Ellis

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