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

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.

448 SYSTEMATIC IMPLEMENTATION OF A REGIONAL MULTIDISCIPLINARY TEAM MEETING IMPROVES PROGNOSIS FOR ESOPHAGEAL CANCER PATIENTS.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
J Luijten ◽  
V Haagsman ◽  
M Luyer ◽  
F Heesakkers ◽  
R Schrauwen ◽  
...  
Keyword(s):  
Decision Making ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
The Netherlands ◽  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Curative Intent ◽  
Team Meeting ◽  
Netherlands Cancer Registry ◽  
The Impact

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.

scholarly journals Decision making of a specialist Aortovascular multidisciplinary team meeting

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Martin T. Yates ◽  
Ana Lopez-Marco ◽  
Michelle Lee ◽  
Benjamin Adams ◽  
John Yap ◽  
...  
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting

scholarly journals Medical and Nonmedical Information during Multidisciplinary Team Meetings in Cancer Care

2021 ◽  
Vol 28 (1) ◽  
pp. 1008-1016
Author(s):  
Jessica Wihl ◽  
Linn Rosell ◽  
Tobias Carlsson ◽  
Sara Kinhult ◽  
Gert Lindell ◽  
...  
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Family Relations ◽  
Patient Characteristics ◽  
Psychological Status ◽  
Treatment Preferences ◽  
Case Discussions ◽  
Case Presentations ◽  
Data Elements

Background: Multidisciplinary team (MDT) meetings provide treatment recommendations based on available information and collective decision-making in teams with complementary professions, disciplines and skills. We aimed to map ancillary medical and nonmedical patient information during case presentations and case discussions in MDT meetings in cancer care. Methods: Through a nonparticipant, observational approach, we mapped verbal information on medical, nonmedical and patient-related characteristics and classified these based on content. Data were collected from 336 case discussions in three MDTs for neuro-oncology, sarcoma and hepato-biliary cancer. Results: Information on physical status was presented in 48.2% of the case discussions, psychological status in 8.9% and comorbidity in 48.5% of the cases. Nonmedical factors, such as family relations, occupation, country of origin and abode were referred to in 3.6–7.7% of the cases, and patient preferences were reported in 4.2%. Conclusions: Provision of information on comorbidities in half of the cases and on patient characteristics and treatment preferences in <10% of case discussions suggest a need to define data elements and develop reporting standards to support robust MDT decision-making.

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