Skip to main content
Top
Published in: Annals of Surgical Oncology 5/2013

01-05-2013 | Healthcare Policy and Outcomes

Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study

Authors: B. W. Lamb, MRCS, C. Taylor, MSc, J. N. Lamb, MBBS, S. L. Strickland, MBBS, C. Vincent, PhD, J. S. A. Green, FRCS (Urol.), N. Sevdalis, PhD

Published in: Annals of Surgical Oncology | Issue 5/2013

Login to get access

Abstract

Background

Multidisciplinary teams (MDTs) are the standard means of making clinical decisions in surgical oncology. The aim of this study was to explore the views of MDT members regarding contribution to the MDT, representation of patients’ views, and dealing with disagreements in MDT meetings—issues that affect clinical decision making, but have not previously been addressed.

Methods

Responses to open questions from a 2009 national survey of MDT members about effective MDT working in the United Kingdom were analyzed for content. Emergent themes were identified and tabulated, and verbatim quotes were extracted to validate and illustrate themes.

Results

Free-text responses from 1,636 MDT members were analyzed. Key themes were: (1) the importance of nontechnical skills, organizational support, and good relationships between team members for effective teamworking; (2) recording of disagreements (potentially sharing them with patients) and the importance of patient-centered information in relation to team decision making; (3) the central role of clinical nurse specialists as the patient’s advocates, complementing the role of physicians in relation to patient centeredness.

Conclusions

Developing team members’ nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration.
Literature
1.
go back to reference The Department of Health. Manual for cancer services. London: The Department of Health; 2004. The Department of Health. Manual for cancer services. London: The Department of Health; 2004.
2.
go back to reference McAvoy B. Optimising cancer care in Australia. Melbourne: National cancer control initiative. Aust Fam Physician. 2003;32:369–72.PubMed McAvoy B. Optimising cancer care in Australia. Melbourne: National cancer control initiative. Aust Fam Physician. 2003;32:369–72.PubMed
4.
go back to reference Wright FC, De Vito C, Langer B, Hunter A. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007;43:1002–10.PubMedCrossRef Wright FC, De Vito C, Langer B, Hunter A. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007;43:1002–10.PubMedCrossRef
5.
go back to reference Chan WF, Cheung PS, Epstein RJ, Mak J. Multidisciplinary approach to the management of breast cancer in Hong Kong. World J Surg. 2007;30:2095–2100.CrossRef Chan WF, Cheung PS, Epstein RJ, Mak J. Multidisciplinary approach to the management of breast cancer in Hong Kong. World J Surg. 2007;30:2095–2100.CrossRef
6.
7.
go back to reference Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7:935–43.PubMedCrossRef Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7:935–43.PubMedCrossRef
8.
go back to reference Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25.PubMedCrossRef Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25.PubMedCrossRef
9.
go back to reference 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. 2003;89:15–22.PubMedCrossRef 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. 2003;89:15–22.PubMedCrossRef
10.
go back to reference Davies AR, Deans DA, Penman I, Plevris JN, Fletcher J, Wall L, et al. The multidisciplinary care team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19:496–503.PubMedCrossRef Davies AR, Deans DA, Penman I, Plevris JN, Fletcher J, Wall L, et al. The multidisciplinary care team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19:496–503.PubMedCrossRef
11.
go back to reference 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. 2006;107:2346–2351.PubMedCrossRef 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. 2006;107:2346–2351.PubMedCrossRef
12.
go back to reference Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17:457–460.PubMedCrossRef Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17:457–460.PubMedCrossRef
13.
go back to reference Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis. 2008;10:769–72.PubMedCrossRef Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis. 2008;10:769–72.PubMedCrossRef
14.
go back to reference Butow P, Harrison JD, Choy ET, Young JM, Spillane A, Evans A. Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer. 2007;110:1937–1944.PubMedCrossRef Butow P, Harrison JD, Choy ET, Young JM, Spillane A, Evans A. Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer. 2007;110:1937–1944.PubMedCrossRef
15.
go back to reference Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012 Apr 26;344:e2718. doi: 10.1136/bmj.e2718.CrossRef Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012 Apr 26;344:e2718. doi: 10.​1136/​bmj.​e2718.CrossRef
16.
go back to reference 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;102:125–134.PubMedCrossRef 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;102:125–134.PubMedCrossRef
17.
go back to reference Houssami N, Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer. 2006;42:2480–91.PubMedCrossRef Houssami N, Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer. 2006;42:2480–91.PubMedCrossRef
19.
go back to reference Tschan F, Semmer NK, Gurtner A, Bizzari L, Spychiger M, Breuer M, et al. Explicit reasoning, confirmation bias, and illusory transactive memory. A simulation study of group medical decision making. Small Group Res. 2009;40:271–300.CrossRef Tschan F, Semmer NK, Gurtner A, Bizzari L, Spychiger M, Breuer M, et al. Explicit reasoning, confirmation bias, and illusory transactive memory. A simulation study of group medical decision making. Small Group Res. 2009;40:271–300.CrossRef
20.
go back to reference Larson JR, Christensen C, Franz TM, Abbott AS. Diagnosing groups: the pooling, management, and impact of shared and unshared case information in team-based medical decision making. J Personal Soc Psychol. 1998;75:93–108.CrossRef Larson JR, Christensen C, Franz TM, Abbott AS. Diagnosing groups: the pooling, management, and impact of shared and unshared case information in team-based medical decision making. J Personal Soc Psychol. 1998;75:93–108.CrossRef
21.
go back to reference Schulz-Hardt S, Brodbeck FC, Mojzisch A, Kerschreiter R, Frey D. Group decision making in hidden profile situations: dissent as a facilitator for decision quality. J Personal Soc Psychol. 1996;91:1080–93. Schulz-Hardt S, Brodbeck FC, Mojzisch A, Kerschreiter R, Frey D. Group decision making in hidden profile situations: dissent as a facilitator for decision quality. J Personal Soc Psychol. 1996;91:1080–93.
22.
go back to reference Christensen C, Abbott AS. Team medical decision making. In: Chapman GB, Sonnenberg FA, editors. Decision making in health care. Cambridge: Cambridge University Press; 2000. p. 267–85. Christensen C, Abbott AS. Team medical decision making. In: Chapman GB, Sonnenberg FA, editors. Decision making in health care. Cambridge: Cambridge University Press; 2000. p. 267–85.
23.
go back to reference Orasanu J, Salas E. Team decision making in complex environments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Stamford: Ablex; 1995. p. 327–45. Orasanu J, Salas E. Team decision making in complex environments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Stamford: Ablex; 1995. p. 327–45.
25.
go back to reference Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JS. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol. 2012;23:1293–300.PubMedCrossRef Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JS. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol. 2012;23:1293–300.PubMedCrossRef
27.
go back to reference Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–116.PubMedCrossRef Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–116.PubMedCrossRef
28.
go back to reference Flin R, O’Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Surrey: Ashgate; 2008. Flin R, O’Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Surrey: Ashgate; 2008.
29.
go back to reference Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116:511–517.PubMedCrossRef Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116:511–517.PubMedCrossRef
30.
go back to reference Lanceley A, Savage J, Menon U, Jacobs I. Influences on multidisciplinary care team decision-making. Int J Gynecol Cancer. 2008;18:215–22.PubMedCrossRef Lanceley A, Savage J, Menon U, Jacobs I. Influences on multidisciplinary care team decision-making. Int J Gynecol Cancer. 2008;18:215–22.PubMedCrossRef
31.
go back to reference Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multidisciplinary breast cancer care teams. Eur J Oncol Nurs. 2004;8:306–314.PubMedCrossRef Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multidisciplinary breast cancer care teams. Eur J Oncol Nurs. 2004;8:306–314.PubMedCrossRef
32.
go back to reference Junnola T, Eriksson E, Salantera S, Lauri S. Nurses’ decision-making in collecting information for the assessment of patients’ nursing problems. J Clin Nurs. 2002;11:186–96.PubMedCrossRef Junnola T, Eriksson E, Salantera S, Lauri S. Nurses’ decision-making in collecting information for the assessment of patients’ nursing problems. J Clin Nurs. 2002;11:186–96.PubMedCrossRef
34.
go back to reference Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the cancer nurse specialist in the urology multidisciplinary care team meeting. Int J Urol Nurs. 2011;5:59–64.CrossRef Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the cancer nurse specialist in the urology multidisciplinary care team meeting. Int J Urol Nurs. 2011;5:59–64.CrossRef
37.
go back to reference Sevdalis N, Harvey N. Predicting preferences: a neglected aspect of shared decision-making. Health Expect. 2006;9:245–51.PubMedCrossRef Sevdalis N, Harvey N. Predicting preferences: a neglected aspect of shared decision-making. Health Expect. 2006;9:245–51.PubMedCrossRef
38.
go back to reference Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R, et al. Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Technol Work. 2004;6:165–71.CrossRef Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R, et al. Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Technol Work. 2004;6:165–71.CrossRef
39.
go back to reference Künzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behaviour: A literature review. Safety Sci. 2010;48:1–17.CrossRef Künzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behaviour: A literature review. Safety Sci. 2010;48:1–17.CrossRef
40.
go back to reference Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA. Teamwork in the operating theatre: cohesion or confusion? J Eval Clin Pract. 2006;12:182–189.PubMedCrossRef Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA. Teamwork in the operating theatre: cohesion or confusion? J Eval Clin Pract. 2006;12:182–189.PubMedCrossRef
41.
go back to reference Lamb BW, Wong H, Vincent C, Green JS, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf. 2011;20:849–56.PubMedCrossRef Lamb BW, Wong H, Vincent C, Green JS, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf. 2011;20:849–56.PubMedCrossRef
42.
go back to reference Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Teamwork and clinical decision-making in multidisciplinary cancer teams: prospective multimethod investigation using cross-validated assessment tools. Ann Surg Oncol. 2011;18(13):3535–3543. doi:10.1245/s10434-011-1773-5. Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Teamwork and clinical decision-making in multidisciplinary cancer teams: prospective multimethod investigation using cross-validated assessment tools. Ann Surg Oncol. 2011;18(13):3535–3543. doi:10.​1245/​s10434-011-1773-5.
43.
go back to reference Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making in multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35:1970–6.PubMedCrossRef Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making in multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35:1970–6.PubMedCrossRef
44.
go back to reference Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh). 2007;127:82–7.CrossRef Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh). 2007;127:82–7.CrossRef
45.
go back to reference Lutterbach J, Pagenstecher A, Spreer J, Hetzel A, Velthoven V, Nikkhah G, et al. The brain tumor board: lessons to be learned from an interdisciplinary conference. Onkologie. 2005;28:22–6.PubMedCrossRef Lutterbach J, Pagenstecher A, Spreer J, Hetzel A, Velthoven V, Nikkhah G, et al. The brain tumor board: lessons to be learned from an interdisciplinary conference. Onkologie. 2005;28:22–6.PubMedCrossRef
46.
go back to reference Sidhom M, Poulsen M. Group decisions in oncology: doctors’ perceptions of the legal responsibilities arising from multidisciplinary meetings. J Med Imaging Radiat Oncol. 2008;52:287–92.PubMedCrossRef Sidhom M, Poulsen M. Group decisions in oncology: doctors’ perceptions of the legal responsibilities arising from multidisciplinary meetings. J Med Imaging Radiat Oncol. 2008;52:287–92.PubMedCrossRef
47.
go back to reference Jarboe S. Procedures for enhancing team decision making. In: Hirokawa RY, Poole MS, editors. Communication and group decision making (2nd ed.). Thousand Oaks: Sage; 1996. Jarboe S. Procedures for enhancing team decision making. In: Hirokawa RY, Poole MS, editors. Communication and group decision making (2nd ed.). Thousand Oaks: Sage; 1996.
48.
go back to reference Duffy L. Team decision-making biases: an information-processing perspective. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Norwood: Ablex; 1995. p. 346–59. Duffy L. Team decision-making biases: an information-processing perspective. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Norwood: Ablex; 1995. p. 346–59.
49.
go back to reference Devitt B, Philip J, McLachlan SA. Team dynamics, decision making, and attitudes toward multidisciplinary cancer meetings: health professionals’ perspectives. J Oncol Pract. 2010;6:e17–e20.PubMedCrossRef Devitt B, Philip J, McLachlan SA. Team dynamics, decision making, and attitudes toward multidisciplinary cancer meetings: health professionals’ perspectives. J Oncol Pract. 2010;6:e17–e20.PubMedCrossRef
50.
go back to reference 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;6:61–68.PubMedCrossRef 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;6:61–68.PubMedCrossRef
51.
go back to reference Lamb BW, Sevdalis N, Vincent C, Green JSA. Development and evaluation of a checklist to support decision-making in cancer multidisciplinary team meetings: MDT-QuIC. Ann Surg Oncol. 2012;19:1759–65.PubMedCrossRef Lamb BW, Sevdalis N, Vincent C, Green JSA. Development and evaluation of a checklist to support decision-making in cancer multidisciplinary team meetings: MDT-QuIC. Ann Surg Oncol. 2012;19:1759–65.PubMedCrossRef
52.
go back to reference Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18:71–5.PubMedCrossRef Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18:71–5.PubMedCrossRef
Metadata
Title
Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study
Authors
B. W. Lamb, MRCS
C. Taylor, MSc
J. N. Lamb, MBBS
S. L. Strickland, MBBS
C. Vincent, PhD
J. S. A. Green, FRCS (Urol.)
N. Sevdalis, PhD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2676-9

Other articles of this Issue 5/2013

Annals of Surgical Oncology 5/2013 Go to the issue