Degrees of Multidisciplinarity Underpinning Care Planning for Patients with Cancer in Weekly Multidisciplinary Team Meetings: Conversation Analysis

Abstract

Purpose: Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK’s Department of Health, UK’s National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. Patients and Methods: This is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the ‘Orientation-Discussion-Decision-Implementation’ framework, and the cancer guidelines. Results: Eight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were 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 meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team. Conclusion: We found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guidelines, and just over 10% not adhering to the group decision-making framework. The findings are in line with the UK recommendation on streamlining MDT meetings and could help decide how to re-organise the meetings to be most efficient. Implications are discussed in relation to quality and safety of care.