Secret sauce in collaborative tumor boards: Team-based characteristics that optimize tumor board functionality.

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.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 34-34
Author(s):  
Deborah Ejem ◽  
J Nicholas Dionne-Odom ◽  
Danny Willis ◽  
Peter Kaufman ◽  
Laura Urquhart ◽  
...  

34 Background: Women with metastatic breast cancer (MBC) face numerous treatment and ACP decisions along their illness trajectory. We aimed to explore the treatment and ACP decision-making processes and decision support needs of women with MBC. Methods: Convergent, parallel mixed methods study (9/08-7/09). Sample included women with MBC managed by 3 breast oncologists at the Norris Cotton Cancer Center, Lebanon, NH. Participants completed a semi-structured interview and standardized decision-making instruments (decision control preferences) at study enrollment (T1; n = 22) and when they faced a decision point or 3 months later (T2; n = 19), whichever came first. Results: Participants (n = 22) where all white, averaged 62 years and were mostly married (54%), retired (45%), had a ≥ bachelor’s degree (45%), and had incomes > $40,000 (50%). On the control preferences scale, most women reported a preference for a ‘shared decision’ with clinician (T1 = 14 (64%) vs T2 = 9 (47%)) compared to making the decision themselves (T1 = 6 (27%) vs T2 = 6 (32%)), or delegating the decision to their doctor (T1 = 2 (9%) vs T2 = 4 (21%)). In semi-structured interviews about their actual treatment decision-making experience, women described experiencing a passive or delegated rather than a shared decision-making process. Conversely, women described a much more active ACP decision-making process that was often shared with family rather than their oncologists. Conclusions: Women selected a “shared” process using a validated tool; however their descriptions of the treatment decision-making processes were inconsistent with their actual experience, which was a more passive process in which they followed the oncologists’ treatment suggestions.


2020 ◽  
Vol 40 (4) ◽  
pp. 540-544
Author(s):  
Patricia I. Jewett ◽  
Rachel I. Vogel ◽  
Mary C. Schroeder ◽  
Joan M. Neuner ◽  
Anne H. Blaes

Background. Having dependent children may affect cancer treatment decisions. We sought to describe women’s surgery and chemotherapy decisions in nonmetastatic breast cancer by parental status. Methods. We conducted a secondary analysis of the 2015 cross-sectional Share Thoughts on Breast Cancer Study, conducted in 7 Midwestern states in the United States, restricted to women of prime parenting age (aged 20–50 years) who consented to the use of their medical records ( N = 225). We examined treatment decisions using data visualization and logistic regression (adjusted for age, stage, family history of breast cancer, income, education, race, health insurance, and partner status). Results. Women with dependent children received bilateral mastectomy more often than women without dependent children (adjusted odds ratio 3.09, 95% confidence interval 1.44–6.62).We found no differences in the receipt of chemotherapy by parental status. Women reported more active roles in surgery than in chemotherapy decision making. Conclusions. As a likely factor in cancer treatment decisions, parental status should be addressed in clinical practice and research. Future research should assess patients’ sense of ownership in treatment decision making by treatment type.


2021 ◽  
pp. 107484072098722
Author(s):  
Ginny L. Schulz ◽  
Katherine Patterson Kelly ◽  
Jane Armer ◽  
Lawrence Ganong

Research on how and why family processes influence phenomena is essential to advancing many areas of science. Case study methods offer an approach that overcomes some of the sampling and analysis obstacles researchers face when studying families. This article aims to illustrate the benefits of case study methods for studying complex family processes using an example from treatment decision-making in sickle cell disease. Using survey, observation, and interview data from various family members within multiple family units, we detail our application of the following analytic strategies: (a) proposition-building, (b) pattern-matching, and (c) cross-case synthesis. Incorporating propositions from a conceptual framework assisted us in study development, data collection, and analysis. Development of graphs and matrices to create thematic family profiles uncovered how and why treatment decision-making occurred as a family process in a pediatric chronic illness. Case study methods are an established, but innovative approach to investigating various phenomena in families.


Author(s):  
Laura Canals-Ruiz ◽  
Marta Comellas ◽  
Luís Lizán

Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.


2017 ◽  
Author(s):  
Arja ter Elst ◽  
Nils A. 't Hart ◽  
Anthonie J. van der Wekken ◽  
Wim Timens ◽  
Lucie B. Hijmering-Kappelle ◽  
...  

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.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19156-e19156
Author(s):  
Barbara Oureilidis-DeVivo

e19156 Background: Hospital tumor boards (TBs) exist to help multidisciplinary specialists determine the best treatment plan for patients through multidisciplinary input and evidence-based treatment recommendations. However, decision-making processes and outcomes vary and may not consistently follow a linear, rational decision-making process or represent evidenced-based clinical guidelines. The ad hoc nature of multidisciplinary cancer teams can create limitations in interoperable functioning, especially in ambiguous environments. Methods: This qualitative ethnographic study explores levels of patient situational complexity under TB review within different structural dynamics in a group and describes how TBs cope with uncertainty when making treatment decisions. The study reports on original research and used ethnographic methods in 44 tumor boards at seven research hospitals in the United States and United Kingdom. Results: Results show TB decision-making process and outcomes are obstructed by the level of situational complexity in each patient’s case depending on the social dynamics of the group. Conclusions: Although multidisciplinary teams provide the benefit of variety in backgrounds and expertise, this structural diversity can also lead to limitations in the actual functioning of a group. By exploring the variations in this decision-making process, a deeper understanding can be reached of how oncology physicians make decisions about the clinical pathway for cancer patients and how this affects TB functionality.


2019 ◽  
Vol 23 (2) ◽  
pp. 295-302 ◽  
Author(s):  
Joseph Marascio ◽  
Daniel E. Spratt ◽  
Jingbin Zhang ◽  
Edouard J. Trabulsi ◽  
Tiffany Le ◽  
...  

Abstract Background Genomic classifiers (GC) have been shown to improve risk stratification post prostatectomy. However, their clinical benefit has not been prospectively demonstrated. We sought to determine the impact of GC testing on postoperative management in men with prostate cancer post prostatectomy. Methods Two prospective registries of prostate cancer patients treated between 2014 and 2019 were included. All men underwent Decipher tumor testing for adverse features post prostatectomy (Decipher Biosciences, San Diego, CA). The clinical utility cohort, which measured the change in treatment decision-making, captured pre- and postgenomic treatment recommendations from urologists across diverse practice settings (n = 3455). The clinical benefit cohort, which examined the difference in outcome, was from a single academic institution whose tumor board predefined “best practices” based on GC results (n = 135). Results In the clinical utility cohort, providers’ recommendations pregenomic testing were primarily observation (69%). GC testing changed recommendations for 39% of patients, translating to a number needed to test of 3 to change one treatment decision. In the clinical benefit cohort, 61% of patients had genomic high-risk tumors; those who received the recommended adjuvant radiation therapy (ART) had 2-year PSA recurrence of 3 vs. 25% for those who did not (HR 0.1 [95% CI 0.0–0.6], p = 0.013). For the genomic low/intermediate-risk patients, 93% followed recommendations for observation, with similar 2-year PSA recurrence rates compared with those who received ART (p = 0.93). Conclusions The use of GC substantially altered treatment decision-making, with a number needed to test of only 3. Implementing best practices to routinely recommend ART for genomic-high patients led to larger than expected improvements in early biochemical endpoints, without jeopardizing outcomes for genomic-low/intermediate-risk patients.


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