Current PerspectiveThe multidisciplinary meeting: An indispensable aid to communication between different specialities
Introduction
In the last few years, the demand for multidisciplinary decision-making in oncology has increased markedly. Previously, a patient with locally advanced non-small cell lung cancer (NSCLC) would undergo surgery and possibly postoperative radiotherapy. Whereas today there is a need to discuss the different diagnostic measures required to determine the exact stage and treatment options, which can include surgery, radiotherapy, and chemotherapy in different combinations and sequences. The established way to deal with these complex issues is multidisciplinary meetings involving key specialists from the diagnostic and therapeutic modalities.
There is evidence that multidisciplinary care has the potential to significantly increase survival.1, 2 However, many other benefits are published, i.e. improving the health outcome of elderly inpatients after discharge,3 increasing resection rate of lung cancers,4 reducing medication variance,5 offering better treatments, follow-up and outcome in hypertension.6 In a US study, the initial treatment recommendation for women with breast cancer was changed following a second opinion of a multidisciplinary panel in 43% of the cases.7 It is well acknowledged that the multidisciplinary decision-making process is able to greatly reduce the wide variations in decisions made by professionals acting independently.8
In oncology there are some recommendations and guidelines for multidisciplinary team-working like in Australia or in the UK9, 10 but there is no universally accepted model of multidisciplinary care. Some cancer centres are offering multidisciplinary clinics where cancer patients can see specialists from various disciplines at one clinic. Another widely used option is to bring the different specialists together to discuss patients multidisciplinary care. These are mostly tumour-specific meetings and are known by different titles: multi-disciplinary meeting (MDM), multidisciplinary teams (MDT), tumour boards, cancer conferences, etc. We are using in this article the acronym ‘MDT’.
These MDT’s are part of everyday life in clinical settings regularly dealing with cancer patients. They often absorb several hours a week of many expensive specialists. A recently published study of breast cancer teams revealed that team composition, working methods and workloads are related to measures of effectiveness.11 It is obvious that the degree of organisation and type of communication in these MDT’s has direct impact on the quality of patient care. In this article, we are evaluating different aspects of organisation and communication of MDT’s.
Section snippets
Different goals and benefits of MDT’s
The primary goal of an MDT is to improve the care management for individual patients. The early implementation of the discussion process in the pathway of an individual patient can prevent unnecessary diagnostic investigations and save valuable time. One multidisciplinary discussion with all involved specialities is more effective and the joint decision more accurate than the sum of all individual opinions. Patients are treated according to the same guidelines and to the same standard
Who should participate in an MDT?
Specific participation is dependant on the type of tumour being discussed, the goals of the MDT as outlined earlier and whether the meeting is to discuss diagnosis or treatment. We will focus here on an MDT meeting with a therapeutic intent.
In general, the three therapeutic modalities of surgery, radiotherapy and medical oncology form the core members of the team. Whatever the purpose of the meeting, it is beneficial to have representatives from the diagnostic specialties there, i.e. radiology,
Announcement of an MDT
Any specialty including the involved GP can bring cases for discussion at the MDT, and indeed, those outside the normal circle of the MDT should be particularly encouraged to bring all cancer cases to such meetings, since it is those cases which are diagnosed outside the ‘normal pathway’, which may benefit the most from being ‘brought into the fold’. It is helpful if a coordinator is appointed to collect the cases together, write and disseminate the agenda. The agenda should be distributed
Additional remarks
It is helpful to create a database of the MDT’s activity allowing the documentation and easy retrieval of the number of patients with a certain diagnosis and stage. This is obviously helpful to sort out likely accrual rates for new trials or also to carry out retrospective studies or audits.
As mentioned above, the MDT is often the main opportunity for communication between different specialists and it is also a chance to learn from each other. Why not occasionally have a brief presentation
Conclusion
MDT’s are now a key component in a professional’s routine and they consume a lot of hours per week. Therefore, we believe it is worthwhile to spend some time thinking about organisations, targets, documentation and collaboration within the group.
Conflict of interest statement
None declared.
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