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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2011

01-12-2011 | Healthcare Policy and Outcomes

Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments

Authors: B. W. Lamb, MRCS, N. Sevdalis, PhD, H. Mostafid, FRCS (Urol.), C. Vincent, PhD, J. S. A. Green, FRCS (Urol.)

Published in: Annals of Surgical Oncology | Issue 13/2011

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Abstract

Purpose

Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members’ contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.

Materials and Methods

Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients’ views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere–Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman’s correlations.

Results

Quality of information presentation: Case histories and radiology information rated highest; patients’ views and comorbidities/psychosocial issues rated lowest (observed: Z = 14.80, P ≤ 0.001; self-report: Z = 3.70, P < 0.001). Contribution to decision-making: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed: Z = 20.00, P ≤ 0.001; self-report: Z = 8.10, P < 0.001). Correlations between observational and self-report assessments: Median Spearman’s rho = 0.74 (range = 0.66–0.91; P < 0.05).

Conclusions

The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.
Literature
1.
2.
The Department of Health. Manual for cancer services. London: The Department of Health; 2004.
3.
McAvoy B. Optimising cancer care in Australia. Melbourne: National Cancer Control Initiative. Aust Fam Physician. 2003; 32(5):369–72.PubMed
4.
Wright FC, Lookhong N, Urbach D, Davis D, McLeod RS, Gagliardi AR. Multidisciplinary cancer conferences: identifying opportunities to promote implementation. Ann Surg Oncol. 2009; 16(10):2731–7.PubMedCrossRef
5.
NHS National Cancer Action Team. Multidisciplinary team members views about MDT working: Results from a survey commissioned by the National Cancer Action Team. London: NHS National Cancer Action Team; 2009.
6.
7.
Hong NJ, Wright FC, Gagliardi AR, Paszat LF. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J Surg Oncol. 2010;102(2):125–34. Review.PubMedCrossRef
8.
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. doi:10.​1245/​s10434-011-1675-6 [Online March 26, 2011].
9.
Forrest LM, McMillan DC, McArdle CS, Dunlop DJ. An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2005;93(9):977–8.PubMedCrossRef
10.
Newman E, Guest A, Helvie M, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006; 107(10):2343–2351.CrossRef
11.
Haward R, Amir Z, Borrill C, et al. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer. 2003; 89(1):15–22.PubMedCrossRef
12.
Look Hong NJ, Gagliardi AR, Bronskill SE, Paszat LF, Wright FC. Multidisciplinary cancer conferences: exploring obstacles and facilitators to their implementation. J Oncol Pract. 2010; 6(2):61–8.PubMedCrossRef
13.
Lamb B, Wong H, Vincent C, et al. Teamwork and team performance in urological multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf. 2011. doi:10.​1136/​bmjqs.​2010.​048660.
14.
Chang JH, Vines E, Bertsch H, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer. 2001; 91(7):1231–7.PubMedCrossRef
15.
Pawlik TM, Laheru D, Hruban RH, et al. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008; 15(8):2081–8.PubMedCrossRef
16.
Bumm R, Feith M, Lordick F, et al. Impact of multidisciplinary tumor boards on diagnosis and treatment of esophageal cancer. Acta Chirurgica Austriaca. 207; 39(3):136–40.
17.
Blazeby JM, Wilson L, Metcalfe C, et al. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006; 17(3):457–60.PubMedCrossRef
18.
Leo F, Venissac N, Poudenx M, et al. Multidisciplinary management of lung cancer: how to test its efficacy? J Thorac Oncol. 2007; 2(1):69–72.PubMedCrossRef
19.
Wood JJ, Metcalfe C, Paes A, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis. 2008;10(8):769–72.PubMedCrossRef
20.
Kidger J, Murdoch J, Donovan JL, et al. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009; 116(4):511–7.PubMedCrossRef
21.
Lanceley A, Savage J, Menon U, et al. Influences on multidisciplinary team decisionmaking. Int J Gynecol Cancer. 2008; 18(2):215–22.PubMedCrossRef
22.
23.
Calland JF, Guerlain S, Adams RB, et al. A systems approach to surgical safety. Surg Endosc. 2002; 16(6):1005–14.PubMedCrossRef
24.
Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004; 239(4):475–82.PubMedCrossRef
25.
Arora S, Tierney T, Sevdalis N, et al. The Imperial Stress Assessment Tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room. World J Surg. 2010; 34(8):1756–63.PubMedCrossRef
26.
Fletcher G, Flin R, McGeorge P, et al. Rating non-technical skills: Developing a behavioural marker system for use in anaesthesia. Cogn Technol Work. 2010; (6):165–71.
27.
Undre S, Sevdalis N, Vincent C. Observing and assessing surgical teams: the observational teamwork assessment for surgery© (OTAS)©. In: Flin R, Mitchell L, editors. Safer surgery: analysing behaviour in the operating theatre, 1st edn. (2009). Derbyshire: Ashgate.
28.
Undre S, Sevdalis N, Healey AN, et al. Observational teamwork assessment for surgery (OTAS): refinement and application in urological surgery. World J Surg. 2007; 31(7):1373–81.PubMedCrossRef
29.
30.
Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003; (3):CD000259.
31.
Undre S, Koutantji M, Sevdalis N, et al. Multidisciplinary crisis simulations: the way forward for training surgical teams. World J Surg. 2007; 31(9):1843–53.PubMedCrossRef
32.
Abell N, Springer DW, Kamata A. Developing and validating rapid assessment instruments. New York: Oxford University Press; 2009.CrossRef
33.
Jonckheere AR. A test of significance for the relation between m rankings and k ranked categories. Br J Stat Psych. 1954; 7: 93–100.CrossRef
34.
Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multidisciplinary breast cancer care teams. Eur J Oncol Nurs. 2004; 8(4):306–14.PubMedCrossRef
35.
Junnola T, Eriksson E, Salantera S, et al. Nurses’ decision-making in collecting information for the assessment of patients’ nursing problems. J Clin Nurs. 2002; 11(2):186–96.PubMedCrossRef
36.
Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh). 2007; 127(1):82–87.CrossRef
37.
Lutterbach J, Pagenstecher A, Spreer J, et al. The brain tumor board: lessons to be learned from an interdisciplinary conference. Onkologie. 2005; 28(1):22–6.PubMedCrossRef
38.
Elwyn G, Laitner S, Coulter A, et al. Implementing shared decision making in the NHS. BMJ. 2010; 341:c5146.PubMedCrossRef
39.
Healey A, Undre S, Vincent C. Developing observational measures of performance in surgical teams. Qual Saf Health Care. 2004;13(Suppl 1):i33–i40.PubMedCrossRef
40.
Yule S, Flin R, Paterson-Brown S, et al. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006; 139(2):140–9.PubMedCrossRef
41.
Künzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behaviour: A literature review. Safety Sci. 2010; 48(1):1–17.CrossRef
Metadata
Title
Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments
Authors
B. W. Lamb, MRCS
N. Sevdalis, PhD
H. Mostafid, FRCS (Urol.)
C. Vincent, PhD
J. S. A. Green, FRCS (Urol.)
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 13/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1773-5

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