How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

Implementing a tumor program strengthening initiative in western Sydney.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19223-e19223
Author(s):  
Lynleigh Evans ◽  
Yiren Liu ◽  
Terence Kwan ◽  
Brendan Donovan ◽  
Karen Byth ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Team Performance ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Program Improvement ◽  
Multidisciplinary Teams ◽  
Improvement Program ◽  
Annual Survey ◽  
Monitoring Performance

e19223 Background: While multidisciplinary teams (MDTs) are well-established in many healthcare institutions, both how they function and their role in decision making vary widely. This study assessed the effectiveness of a multipronged approach to strengthening multidisciplinary team performance for a cancer service over three years. Methods: The study comprised the introduction of a structured quality improvement program, the Tumour Program Strengthening Initiative (TPSI), to improve MDT performance, and an annual survey to evaluate MDT members’ perceptions of their teams’ performance. Three iterations of the survey have been completed. Results: 12 teams participated in TPSI with 129, 118, and 146 members completing the MDT member survey in 2017, 2018, and 2019 respectively. Of the 18 questions that were asked throughout the study, nine showed significant improvement, and of these, seven were highly significant. Questions related to patient wellbeing and to audits and quality improvement showed no significant change. Conclusions: The Tumour Program Strengthening Initiative resulted in sustained and significant improvement in MDT performance over three years. The MDT survey proved to be useful not only for cancer care teams to identify their strengths and weaknesses and monitoring performance but also for management to flag priority areas for improvement and further support. The significance of this initiative is that overall program improvement reflects the strengthening of the weakest teams as well as further improvement in highly performing MDTs. [Table: see text]

Multidisciplinary teams in cancer care: are they effective in the UK?

2006 ◽  
Vol 7 (11) ◽  
pp. 935-943 ◽  
Author(s):  
Anne Fleissig ◽  
Valerie Jenkins ◽  
Susan Catt ◽  
Lesley Fallowfield
Keyword(s):  
Cancer Care ◽  
Multidisciplinary Teams ◽  
The Uk

scholarly journals Introduction to the United Kingdom National Multidisciplinary Guidelines for Head and Neck Cancer

2016 ◽  
Vol 130 (S2) ◽  
pp. S3-S4 ◽  
Author(s):  
V Paleri ◽  
N Roland
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Good Practice ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
The United Kingdom ◽  
The Uk

AbstractThis is the 5th edition of the UK Multi-Disciplinary Guidelines for Head and Neck Cancer, endorsed by seven national specialty associations involved in head and neck cancer care. Our aim is to provide a document can be used as a ready reference for multidisciplinary teams and a concise easy read for trainees. All evidence based recommendations in this edition are indicated by ‘(R)’ and where the multidisciplinary team of authors consider a recommendation to be based on clinical experience, it is denoted by ‘(G)’ as a good practice point.

Benchmarking Risk Analysis Practice in the International Water Sector

2006 ◽  
Vol 1 (2) ◽  
Author(s):  
B.H. MacGillivray ◽  
P.D. Hamilton ◽  
S.E. Hrudey ◽  
L. Reekie ◽  
S.J.T Pollard
Keyword(s):  
Decision Making ◽  
Risk Analysis ◽  
Water Utilities ◽  
Water Sector ◽  
Water Utility ◽  
Analysis Techniques ◽  
The Usa ◽  
International Water ◽  
Practical Guidance ◽  
The Uk

Risk analysis in the water utility sector is fast becoming explicit. Here, we describe application of a capability model to benchmark the risk analysis maturity of a sub-sample of eight water utilities from the USA, the UK and Australia. Our analysis codifies risk analysis practice and offers practical guidance as to how utilities may more effectively employ their portfolio of risk analysis techniques for optimal, credible, and defensible decision making.

The Law & Politics of Brexit: Volume II

2020 ◽  
Keyword(s):  
Decision Making ◽  
European Union ◽  
Legal Framework ◽  
Comprehensive Analysis ◽  
The European Union ◽  
Trade Relations ◽  
The United Kingdom ◽  
The Uk ◽  
Financial Settlement ◽  
The Eu

This book provides the first comprehensive analysis of the withdrawal agreement concluded between the United Kingdom and the European Union to create the legal framework for Brexit. Building on a prior volume, it overviews the process of Brexit negotiations that took place between the UK and the EU from 2017 to 2019. It also examines the key provisions of the Brexit deal, including the protection of citizens’ rights, the Irish border, and the financial settlement. Moreover, the book assesses the governance provisions on transition, decision-making and adjudication, and the prospects for future EU–UK trade relations. Finally, it reflects on the longer-term challenges that the implementation of the 2016 Brexit referendum poses for the UK territorial system, for British–Irish relations, as well as for the future of the EU beyond Brexit.

scholarly journals What’s in a (Change of) Name? Much—but Not That Much—and Not What Wiebe Claims

2020 ◽  
Vol 32 (2) ◽  
pp. 159-184 ◽  
Author(s):  
Satoko Fujiwara ◽  
Tim Jensen
Keyword(s):  
Decision Making ◽  
Executive Committee ◽  
International Association ◽  
International Committee ◽  
Academic Standards ◽  
General Assembly ◽  
Final Decision ◽  
Points Of View ◽  
The Difference ◽  
Consultative Body

Abstract Donald Wiebe claims that the IAHR leadership (already before an Extended Executive Committee (EEC) meeting in Delphi) had decided to water down the academic standards of the IAHR with a proposal to change its name to “International Association for the Study of Religions.” His criticism, we argue, is based on a series of misunderstandings as regards: 1) the difference between the consultative body (EEC) and the decision-making body (EC), 2) the difference between the preliminary points of view of individuals and final proposals by the EC, 3) personal conversations, 4) the link between the proposal to change the name and the wish to tighten up the academic profile of the IAHR. Moreover, if the final decision-making bodies, the International Committee and the General Assembly, adopt the proposal, the new name as little as the old can make the IAHR more or less scientific. Tightening up the academic, scientific profile of the IAHR takes more than a change of name.

scholarly journals Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Hasselberg ◽  
K. H. Holgersen ◽  
G. M. Uverud ◽  
J. Siqveland ◽  
B. Lloyd-Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
Crisis Resolution ◽  
Health Crisis ◽  
The Core ◽  
Crisis Resolution Teams ◽  
Fidelity Scale ◽  
The Uk ◽  
Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

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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