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JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. VII, n 1, June, 2020

Pages: 764-769
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Evaluation of the Decision-Making Mode during Digestive Oncology Multidisciplinary Meetings: a Prospective Study in a Moroccan Center

Author: Chaimae Charoui, Amine Souadka, Saber Boutayeb, Rachida Latib, Laila Rifai, Laila Amrani, Amine Benkabbou, Raouf Mohsine, Mohammed Anass Majbar

Category: JMSR Oncology

Abstract:

Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.

Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients' point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).

Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.

Keywords: Decision making, Quality improvement, Multidisciplinary concertation meeting, MDT-MODe, Morocco

DOI: 10.46327/msrjg.1.000000000000169

DOI URL: https://doi.org/10.46327/msrjg.1.000000000000169

References:

1. Choudhury N, Hassen Y, Siddiqui J, Falzon A, Ghufoor K. A multidisciplinary audit of head and neck referrals: considerations for patients’ timelines and outcomes. Eur Arch Otorhinolaryngol [Internet]. 2013 Nov;270(12):3121–6. Available from: http://dx.doi.org/10.1007/s00405-013-2453-9

2. Lamb BW, Brown KF, Nagpal K, Vincent C, Green JSA, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol [Internet]. 2011 Aug;18(8):2116–25. Available from: http://dx.doi.org/10.1245/s10434-011-1675-6

3. Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol [Internet]. 2006 Nov;7(11):935–43. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1470204506709408

4. Newman EA, Guest AB, Helvie MA, Roubidoux MA, Chang AE, Kleer CG, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer [Internet]. 2006 Nov 15;107(10):2346–51. Available from: http://dx.doi.org/10.1002/cncr.22266

5. Gandamihardja TAK, Soukup T, McInerney S, Green JSA, Sevdalis N. Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making. World J Surg [Internet]. 2019 Feb;43(2):559–66. Available from: http://dx.doi.org/10.1007/s00268-018-4815-3

6. Taylor C, Atkins L, Richardson A, Tarrant R, Ramirez A-J. Measuring the quality of MDT working: an observational approach. BMC Cancer [Internet]. 2012 May 29;12:202. Available from: http://dx.doi.org/10.1186/1471-2407-12-202

7. Haward R, Amir Z, Borrill C, Dawson J, Scully J, West M, et al. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer [Internet]. 2003 Jul 7;89(1):15–22. Available from: http://dx.doi.org/10.1038/sj.bjc.6601073

8. Jalil R, Akhter W, Lamb BW, Taylor C, Harris J, Green JSA, et al. Validation of team performance assessment of multidisciplinary tumor boards. J Urol [Internet]. 2014 Sep;192(3):891–8. Available from: http://dx.doi.org/10.1016/j.juro.2014.03.002

9. Lamb B, Green JSA, Vincent C, Sevdalis N. Decision making in surgical oncology. Surg Oncol [Internet]. 2011 Sep;20(3):163–8. Available from: http://dx.doi.org/10.1016/j.suronc.2010.07.007

10. Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg [Internet]. 2011 Sep;35(9):1970–6. Available from: http://dx.doi.org/10.1007/s00268-011-1152-1

11. Jalil R, Ahmed M, Green JSA, Sevdalis N. Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: an interview study of the provider perspective. Int J Surg [Internet]. 2013 Mar 14;11(5):389–94. Available from: http://dx.doi.org/10.1016/j.ijsu.2013.02.026

12. Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JSA. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol [Internet]. 2012 May;23(5):1293–300. Available from: http://dx.doi.org/10.1093/annonc/mdr453

13. Raine R, Xanthopoulou P, Wallace I, Nic A’ Bháird C, Lanceley A, Clarke A, et al. Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study. BMJ Qual Saf [Internet]. 2014 Oct;23(10):867–76. Available from: http://dx.doi.org/10.1136/bmjqs-2014-002818

14. Soukup T, Petrides KV, Lamb BW, Sarkar S, Arora S, Shah S, et al. The anatomy of clinical decision-making in multidisciplinary cancer meetings: A cross-sectional observational study of teams in a natural context. Medicine [Internet]. 2016 Jun;95(24):e3885. Available from: http://dx.doi.org/10.1097/MD.0000000000003885

15. Shah S, Arora S, Atkin G, Glynne-Jones R, Mathur P, Darzi A, et al. Decision-making in Colorectal Cancer Tumor Board meetings: results of a prospective observational assessment. Surg Endosc [Internet]. 2014 Oct;28(10):2783–8. Available from: http://dx.doi.org/10.1007/s00464-014-3545-3

16. Lamb BW, Green JSA, Benn J, Brown KF, Vincent CA, Sevdalis N. Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients. J Am Coll Surg [Internet]. 2013 Sep;217(3):412–20. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2013.04.035

17. Lamb BW, Wong HWL, Vincent C, Green JSA, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf [Internet]. 2011 Oct;20(10):849–56. Available from: http://dx.doi.org/10.1136/bmjqs.2010.048660

18. Lamb BW, Sevdalis N, Benn J, Vincent C, Green JSA. Multidisciplinary cancer team meeting structure and treatment decisions: a prospective correlational study. Ann Surg Oncol [Internet]. 2013 Mar;20(3):715–22. Available from: http://dx.doi.org/10.1245/s10434-012-2691-x

19. Lamb BW, Wong HWL, Vincent C, Green JSA, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf [Internet]. 2011 Oct;20(10):849–56. Available from: http://dx.doi.org/10.1136/bmjqs.2010.048660

20. Hahlweg P, Didi S, Kriston L, Härter M, Nestoriuc Y, Scholl I. Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study. BMC Cancer [Internet]. 2017 Nov 17;17(1):772. Available from: http://dx.doi.org/10.1186/s12885-017-3768-5

21. Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol [Internet]. 2011 Dec;18(13):3535–43. Available from: http://dx.doi.org/10.1245/s10434-011-1773-5

22. Jawaid Shaw, Jasmohan S Bajaj. Is There Evidence of the "Hawthorne Effect" in Quality Improvement of Nutritional Consultation in Inpatients With Cirrhosis? Liver Transpl. 2020 May 7. doi: 10.1002/lt.25791. Online ahead of print.