A measure of case complexity for cancer multidisciplinary teams: Development and early validation of the MeDiC tool

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Abigail Morbi ◽  
Ben W Lamb ◽  
Tasha Gandamihardja ◽  
Katy Hogben ◽  
...  
Keyword(s):  
Phase 1 ◽  
Psychometric Evaluation ◽  
Tumor Board ◽  
Multidisciplinary Teams ◽  
Content Validation ◽  
Expert Review ◽  
Case Complexity ◽  
Ethnographic Interviews ◽  
Tumor Boards ◽  
Early Validation

Background and Objective. There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (i.e., in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned, however no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool.Methods. We used a mixed-methods approach involving psychometric evaluation and expert review to develop the Measure of case-Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in 6 phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert-team reviews.Results. Phase-1: case complexity factors identified through literature review and expert interviews; Phase-2: 51 factors subjected to iterative review and content validation by 9 cancer teams across 4 England Trusts with 9 further items identified; Phase 3: 60-items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey. Phases 5 and 6: excellent inter-assessor reliability between clinical and non-clinical observers, and adequate validity on 903 video case-discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC.Conclusions. MeDiC is an evidence-based and expert-driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization.

scholarly journals NCOG-75. ESTIMATED PHYSICIAN COST OF A NEURO-ONCOLOGY MULTIDISCIPLINARY TEAM (MDT) TUMOR BOARD MEETING AT A SINGLE ACADEMIC CENTER

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii146-ii146
Author(s):  
Brett Schroeder ◽  
Jerome Graber ◽  
Emmanuel Cuevas
Keyword(s):  
Performance Metrics ◽  
Tumor Board ◽  
Multidisciplinary Teams ◽  
Radiation Oncologists ◽  
Annual Salary ◽  
Academic Center ◽  
Tumor Boards ◽  
The Mean ◽  
Patient Prognosis ◽  
The Impact

Abstract BACKGROUND Multidisciplinary teams (MDTs) to improve coordination across disciplines have become commonplace in oncology. Quantifying the impact of MDTs is challenging, and they carry significant costs. Weekly neuro-oncology tumor boards are attended by neuro-oncologists, neurosurgeons, radiation-oncologists, neuro-radiologists, neuro-pathologists, and support staff including mid-level practitioners, research coordinators, social workers, nurses and trainees. Our aim was to estimate costs associated with neuro-oncology MDTs. METHODS The estimated physician cost of MDT meetings were calculated from reported salaries of each physician specialty. Annual salaries from the Doximity 2019 Physician Compensation Report (PCR) included data for 4 neurosurgeons, 4 radiation-oncologists, 2 radiologists, 2 oncologists, and 2 neurologists. Medscape 2019 PCR data was compiled for 4 general surgeons, 2 radiologists, 2 oncologists, 2 pathologists, and 2 neurologists. The Physician Wages Across Specialties by Leigh in 2011 (JAMA) was utilized for 4 neurosurgeons, 4 radiation oncologists, 2 oncologists, and 2 neurologists. Annual salary data was divided by annual hours per specialty as reported by the Annual Work Hours Across Specialties, 2011. These values were then applied to an MDT for one patient, one hour, weekly, and annually. RESULTS The Doximity 2019 PCR yielded a per meeting cost of $2,520.84, and an annual cost of $131,083.68. The Medscape 2019 PCR produced a cost of $1,570.60 weekly, and $81,671.20 annually. JAMA data estimated a per meeting cost of $1,448.06, and $75.299.12. The mean per meeting and annual costs were $1846.50, and $96,018.00, respectively. With 6-10 cases per MDT, the mean costs per patient were $184.65 to $307.75. CONCLUSIONS Costs of MDT are not negligible. The impact of MDTs on patient outcomes are harder to quantify, but evidence exists that organized MDTs improve patient prognosis, and unorganized MDTs may negatively affect prognosis. Processes to streamline MDTs could help answer outcomes research questions, improve efficiency, and generate clinically relevant performance metrics.

An ethnographic study illuminating the effect of endogenous and exogenous uncertainty on tumor board decision making.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19156-e19156
Author(s):  
Barbara Oureilidis-DeVivo
Keyword(s):  
Decision Making ◽  
Ad Hoc ◽  
Treatment Plan ◽  
The United States ◽  
Ethnographic Study ◽  
Tumor Board ◽  
Multidisciplinary Teams ◽  
Original Research ◽  
Decision Making Process ◽  
Tumor Boards

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.

Tumor Boards: Optimizing the Structure and Improving Efficiency of Multidisciplinary Management of Patients with Cancer Worldwide

2014 ◽  
pp. e461-e466 ◽  
Author(s):  
Nagi S. El Saghir ◽  
Nancy L. Keating ◽  
Robert W. Carlson ◽  
Katia E. Khoury ◽  
Lesley Fallowfield
Keyword(s):  
United States ◽  
Decision Making ◽  
The United States ◽  
Tumor Board ◽  
Limited Resources ◽  
Multidisciplinary Teams ◽  
Multidisciplinary Management ◽  
Small Community ◽  
Patients With Cancer ◽  
Tumor Boards

Multidisciplinary management tumor boards are now conducted worldwide for the management of patients with cancer. Studies evaluating their influence on decision making and patient outcome are limited; however, single-center studies have reported significant changes in diagnosis and treatment plans. A survey from Arabic countries showed widespread use and reliance on tumor boards for decision making. A recent multi-institutional survey of veteran affairs (VA) hospitals in the United States found limited association between the presence of tumor boards and care and outcomes. The Cancer Care Outcomes Research and Surveillance Consortium looked at the association between tumor board features and measures of quality of care. Results of overall survival among the patients of these physicians participating in tumor boards is ongoing, but preliminary results are outlined along with a recent ASCO survey of international members on the presence, utilization, and influence of tumor boards in this article. Tumor boards allow for implementation of clinical practice guidelines and may help capture cases for clinical trials. Efforts to improve preparations, structure, and conduct of tumor boards, research methods to monitor their performance, teamwork, and outcomes are outlined also in this article. The concept of mini-tumor boards and more efficient methods for MDM in countries with limited resources are also discussed. In suboptimal settings, such as small community hospitals, rural areas, and areas with limited resources, boundaries in diagnosis and management can be overcome, or at least improved, with tumor boards, especially with the use of video-conferencing facilities. Studies from the United Kingdom showed that special training of multidisciplinary teams (MDT) led to better team dynamics and communication, improved patient satisfaction, and improved clinical outcome. The weight of the benefits versus the time and effort spent to improve efficiency, patient care, and better time management in the United States and in the international oncology community is also reviewed in this article.

scholarly journals A measure of case complexity for streamlining workflow in multidisciplinary tumor boards: Mixed methods development and early validation of the MeDiC tool

2020 ◽  
Vol 9 (14) ◽  
pp. 5143-5154 ◽  
Author(s):  
Tayana Soukup ◽  
Abigail Morbi ◽  
Benjamin W. Lamb ◽  
Tasha A.K. Gandamihardja ◽  
Katy Hogben ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Case Complexity ◽  
Methods Development ◽  
Tumor Boards ◽  
Early Validation

Virtual Clinical and Precision Medicine Tumor Boards: A Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era. (Preprint)

2020 ◽  
Author(s):  
Livio Blasi ◽  
Roberto Bordonaro ◽  
Vincenzo Serretta ◽  
Dario Piazza ◽  
Alberto Firenze ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Pathways ◽  
Prospective Trial ◽  
Banking System ◽  
Outcome Data ◽  
Tumor Board ◽  
Time Saving ◽  
Tumor Boards ◽  
Multidisciplinary Tumor Board

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

scholarly journals Complexities of Next-Generation Sequencing in Solid Tumors: Case Studies

2020 ◽  
Vol 18 (9) ◽  
pp. 1150-1155
Author(s):  
Alexandra O. Sokolova ◽  
Brian H. Shirts ◽  
Eric Q. Konnick ◽  
Ginger J. Tsai ◽  
Bernardo H.L. Goulart ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Case Studies ◽  
Checkpoint Inhibitors ◽  
Hereditary Cancer Syndrome ◽  
Next Generation ◽  
Cancer Syndrome ◽  
Expert Review ◽  
Tumor Boards ◽  
Tumor Sequencing ◽  
Generation Sequencing

With the promise and potential of clinical next-generation sequencing for tumor and germline testing to impact treatment and outcomes of patients with cancer, there are also risks of oversimplification, misinterpretation, and missed opportunities. These issues risk limiting clinical benefit and, at worst, perpetuating false conclusions that could lead to inappropriate treatment selection, avoidable toxicity, and harm to patients. This report presents 5 case studies illustrating challenges and opportunities in clinical next-generation sequencing interpretation and clinical application in solid tumor oncologic care. First is a case that dissects the origin of an ATM mutation as originating from a hematopoietic clone rather than the tumor. Second is a case illustrating the potential for tumor sequencing to suggest germline variants associated with a hereditary cancer syndrome. Third are 2 cases showing the potential for variant reclassification of a germline variant of uncertain significance when considered alongside family history and tumor sequencing results. Finally, we describe a case illustrating challenges with using microsatellite instability for predicting tumor response to immune checkpoint inhibitors. The common theme of the case studies is the importance of examining clinical context alongside expert review and interpretation, which together highlight an expanding role for contextual examination and multidisciplinary expert review through molecular tumor boards.

scholarly journals Digital Tumor Board Solutions Have Significant Impact on Case Preparation

2020 ◽  
pp. 757-768
Author(s):  
Richard D. Hammer ◽  
Donna Fowler ◽  
Lincoln R. Sheets ◽  
Athanasios Siadimas ◽  
Chaohui Guo ◽  
...  
Keyword(s):  
Care Center ◽  
Tumor Board ◽  
Preparation Time ◽  
Implementation Phase ◽  
Health Care Center ◽  
Multiple User ◽  
Tumor Boards ◽  
User Groups ◽  
The Impact ◽  
Nose And Throat

PURPOSE Multidisciplinary tumor boards (TBs) are the gold standard for decision-making in cancer care. Variability in preparation, conduction, and impact is widely reported. The benefit of digital technologies to support TBs is unknown. This study evaluated the impact of the NAVIFY Tumor Board solution (NTB) on TB preparation time across multiple user groups in 4 cancer categories: breast, GI, head and neck (ie, ear, nose, and throat, or ENT), and hematopathology. METHODS This prospective study evaluated TB preparation time in multiple phases pre- and post-NTB implementation at an academic health care center. TB preparation times were recorded for multiple weeks using a digital time tracker. RESULTS Preparation times for 59 breast, 61 GI, 36 ENT, and 71 hematopathology cancer TBs comparing a pre-NTB phase to 3 phases of NTB implementation were evaluated between February 2018 and July 2019. NTB resulted in significant reductions in overall preparation time (30%) across 3 TBs pre-NTB compared with the final post-NTB implementation phase. In the breast TB, NTB reduced overall preparation time by 28%, with a 76% decrease in standard deviation (SD). In the GI TB, a 23% reduction in average preparation time was observed for all users, with a 48% decrease in SD. In the ENT TB, a 33% reduction in average preparation time was observed for all users, with a 73% decrease in SD. The hematopathology TB, which was the cocreation partner and initial adopter of the solution, showed variable results. CONCLUSION This study showed a significant impact of a digital solution on time preparation for TBs across multiple users and different TBs, reflecting the generalizability of the NTB. Adoption of such a solution could improve the efficiency of TBs and have a direct economic impact on hospitals.

scholarly journals Comparison of Treatment Recommendations by Molecular Tumor Boards Worldwide

2018 ◽  
pp. 1-14 ◽  
Author(s):  
Damian T. Rieke ◽  
Mario Lamping ◽  
Marissa Schuh ◽  
Christophe Le Tourneau ◽  
Neus Basté ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Treatment Recommendations ◽  
Tumor Board ◽  
Precision Oncology ◽  
Genomic Information ◽  
Specific Patient ◽  
Rational Decision Making ◽  
Copy Numbers ◽  
Tumor Boards ◽  
Molecular Profiles

Purpose Precision oncology holds the promise of improving patient outcome. It is based on the idea that the testing of genomic biomarkers can lead to the recommendation of a treatment option tailored to the specific patient. To derive treatment recommendations from molecular profiles, interdisciplinary molecular tumor boards (MTBs) have been established recently in many academic institutions. The recommendation process in MTBs, however, has not been well defined, which limits applicability to larger clinical trials and patient populations. Methods We created four fictional patients on the basis of recent real cases with genomic information on mutations, fusions, copy numbers, and gene expression. We identified 29 tumor boards from nine countries worldwide and asked them to provide treatment recommendations for the sample patients. In addition, a questionnaire regarding the setup and methods used by MTBs was circulated. Results Five MTBs from four countries provided treatment recommendations and answered the questionnaire. For one patient, three tumor board treatment recommendations were identical, and two tumor boards had identical treatment strategies for the other three patients. There was heterogeneity in the interpretation of tumor and germline aberrations as well as in standards of prioritization. Conclusion Differences in the interpretation and recommendation process contribute to heterogeneity in MTB recommendations. Additional comparative analyses of recommendations could help improve rational decision making and lead to standardization.

scholarly journals Validation of a Questionnaire Developed to Evaluate a Pediatric eHealth Website for Parents

2020 ◽  
Vol 17 (8) ◽  
pp. 2671 ◽  
Author(s):  
Bruno José Nievas Soriano ◽  
Sonia García Duarte ◽  
Ana María Fernández Alonso ◽  
Antonio Bonillo Perales ◽  
Tesifón Parrón Carreño
Keyword(s):  
Factor Analysis ◽  
Goodness Of Fit ◽  
Fit Indices ◽  
Content Validation ◽  
Confirmatory Factor Analyses ◽  
Expert Review ◽  
Confirmatory Factor ◽  
Competing Models ◽  
Confirmatory Analysis ◽  
Adequate Internal Consistency

There is a need for health professionals to provide parents with not only evidence-based child health websites but also instruments to evaluate them. The main aim of this research was to develop a questionnaire for measuring users’ evaluation of the usability, utility, confidence, the well-child section, and the accessibility of a Spanish pediatric eHealth website for parents. We further sought to evaluate the content validity and psychometric reliability of the instrument. A content validation study by expert review was performed, and the questionnaire was pilot tested. Psychometric analyses were used to establish scales through exploratory and confirmatory factor analyses. Reliability studies were performed using Cronbach’s alpha and two split-half methods. The content validation of the questionnaire by experts was considered as excellent. The pilot web survey was completed by 516 participants. The exploratory factor analysis excluded 27 of the 41 qualitative initial items. The confirmatory factor analysis of the resultant 14-item questionnaire confirmed the five initial domains detected in the exploratory confirmatory analysis. The goodness of fit for the competing models was established through fit indices and confirmed the previously established domains. Adequate internal consistency was found for each of the subscales as well as the overall scale.

scholarly journals A mixed-methods study of challenges experienced by clinical teams in measuring improvement

2019 ◽  
pp. bmjqs-2018-009048 ◽  
Author(s):  
Thomas Woodcock ◽  
Elisa G Liberati ◽  
Mary Dixon-Woods
Keyword(s):  
Professional Community ◽  
Multidisciplinary Teams ◽  
Expert Review ◽  
Arduous Task ◽  
Independent Evaluation ◽  
Local Selection ◽  
Improvement Programme ◽  
Two Phases ◽  
Analytical Approaches ◽  
Selection Of

ObjectiveMeasurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures.MethodsDrawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams’ experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016.ResultsDeveloping and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches.ConclusionMeasurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians’ motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.

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