Purifying and hybridising categories in healthcare decision-making: the clinic, the home and the multidisciplinary team meeting

Abstract Surgery for esophageal cancer (EC) has been centralized in the Netherlands. However, patients are still diagnosed in referral centers and not all patients are discussed with a resection center. The aim of this study was to examine the impact of the implementation of the regional Upper-GI video multidisciplinary team meeting (MDT) in the Eindhoven region in which all regional patients should be discussed, on the decision-making process, treatment, and survival of patients with EC. Methods All patients diagnosed between 2012 and 2018 with EC, in hospitals currently working together with the Catharina hospital, were selected from the Netherlands Cancer Registry (n = 1119). The regional MDT was implemented in 2 hospitals in May 2014 and the other hospitals gradually joined. The primary outcome of this study was the proportion of patients discussed in any MDT. Secondary outcomes were involvement of a resection center in MDT, treatment and survival. Outcomes were described prior to and after participation in the regional MDT and analyzed by chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall survival. Results Since participation in the regional MDT more patients were discussed in any MDT (80%-89%, p < 0.0001) and involvement of a resection center during the MDT almost doubled (43%-82%, p < 0.0001). The proportion of patient who underwent treatment with a curative intent remained the same (75%). However, esophagectomy (41%-43%) and endoscopic resections (2%-6%) were performed more often and the use of definitive chemoradiation therapy decreased (31%-25%)(p = 0.049). The use of palliative systemic therapy increased (39%-52%, p < 0.001). Three-year overall survival for all EC patients increased significantly (24%-32%, p < 0.02)(Figure). A non-significant increase in 3-year survival in potentially curable patients (38%-48%, p = 0.09) and 1-year survival in palliative patients (18%-26%, p = 0.13) was observed. Conclusion After implementation of the regional MDT more EC patients were discussed during a MDT and also more often with the involvement of a resection center. This is the first study showing an association of the implementation of a regional MDT with an improved survival. Hypothetically, the implementation of the regional tumor specific video MDT could have had a positive effect on the quality and effectiveness of decision making in patients diagnosed with EC.

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774 TEAM DYNAMICS AND CLINICIAN’S PERSONAL BELIEVES IN TREATMENT OPTIONS INFLUENCE MULTIDISCIPLINARY TREATMENT DECISION-MAKING DURING AN ONCOLOGIC UPPER GASTROINTESTINAL MULTIDISCIPLINARY TEAM-MEETING

Diseases of the Esophagus ◽

10.1093/dote/doab052.774 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Josianne Luijten ◽

Marjan Westerman ◽

Pauline Vissers ◽

Rob Verhoeven ◽

Grard Nieuwenhuijzen

Keyword(s):

Decision Making ◽

Multidisciplinary Team ◽

Clinical Decision Making ◽

Multidisciplinary Treatment ◽

Patient Characteristics ◽

Team Dynamics ◽

Multidisciplinary Team Meeting ◽

Curative Intent ◽

Team Meeting ◽

Esophagogastric Cancer

Abstract The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer affecting survival negatively. Little is known which factors attribute to this variation. The aim of this study is to investigate the possible differences in clinical decision-making (CDM) during the multidisciplinary team meeting (MDTM). Methods A mixed method study design consisting of quantitative and qualitative data was conducted in which thematic content analysis of the current sub-study focused on the 16 MDTM observations and transcripts of 30 semi-structured interviews with clinicians was performed. Interviews were transcribed ad verbatim and coded. Seven focus groups were held to enrich, further explore and validate the gathered data. Results Clinician’s personality traits including ambition and the intention to be innovative were mentioned as facilitators, whereas hierarchy was mentioned as a barrier in CDM. Physician’s believes in a certain treatment and previous experiences with treatment outcomes and team dynamics within the MDTM influenced CDM. A continuum was identified in which at one end hospitals tended to be more guideline and evidence minded and at the other end of the continuum hospitals tended to search for boundaries maximizing chances of curation. All hospitals took patient characteristics in consideration. Conclusion Mechanisms influencing decision-making consisted of following guidelines, using evidence-based medicine, searching for boundaries, and taking patient characteristics into consideration. Nevertheless, the extend in which hospitals involved these mechanisms in their CDM differed. Variation in team dynamics was observed and awareness should be created that these factors attribute to CDM during an MDTM.

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Faculty Opinions recommendation of Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725639466.793512980 ◽

2016 ◽

Author(s):

Nanette Wenger

Keyword(s):

Older Adults ◽

Decision Making ◽

Healthcare Decision ◽

Trade Offs ◽

Healthcare Decision Making

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Faculty Opinions recommendation of Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726361294.793524894 ◽

2016 ◽

Author(s):

Jay H Ryu

Keyword(s):

Cohort Study ◽

Lung Disease ◽

Multidisciplinary Team ◽

Multidisciplinary Team Meeting ◽

Team Meeting ◽

Diffuse Parenchymal Lung Disease ◽

Parenchymal Lung Disease ◽

Parenchymal Lung

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Comparative effectiveness research in the USA: when will there be an impact on healthcare decision-making?

Journal of Comparative Effectiveness Research ◽

10.2217/cer.0018 ◽

2016 ◽

Author(s):

Kimberly D Westrich ◽

Jess A Wilhelm ◽

Claudia L Schur

Keyword(s):

Decision Making ◽

Comparative Effectiveness Research ◽

Comparative Effectiveness ◽

Effectiveness Research ◽

Healthcare Decision ◽

Healthcare Decision Making ◽

The Usa

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Nursing Home Staff’s Perceptions of Healthcare Decision Making for Unbefriended Residents

Innovation in Aging ◽

10.1093/geroni/igaa057.1237 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 384-384

Author(s):

Hyejin Kim ◽

Molly Perkins ◽

Thaddeus Pope ◽

Patricia Comer ◽

Mi-Kyung Song

Keyword(s):

Decision Making ◽

Geographic Area ◽

Care Physician ◽

Healthcare Decision ◽

Do Not Resuscitate ◽

Best Interest ◽

Care Plans ◽

Course Of Action ◽

Healthcare Decision Making ◽

Facility Level

Abstract ‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.

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