Introduction Significant improvements in the quality assurance of endoscopy have occurred driven partly by Bowel Cancer Screening. The same focus on quality however, has not been applied to the Colorectal Cancer (CRC) MDT process where key management decisions are made for patients diagnosed with CRC. Objectives: 1. Quantify quality of clinical information at MDT 2. Quantify core specialty contribution to MDT.
Method Two independent clinical evaluators prospectively rated CRC MDTs. A previously validated MDT team evaluation tool1was adapted following tiered focus groups with core members. This tool objectively measures quality of clinical data, relative contribution and quality of discussion by core specialities and case note availability for each patient.
Results 412 MDT patient discussions over 27 meetings were prospectively analysed (216 pre and 196 post-treatment). 217 (53%) patients were double-rated. Inter-rater reliability was acceptable with weighted kappa coefficients of 0.52 for information and 0.37 for specialty input scores. The mean scores are presented in Table 1for information and Table 2 for specialty input. Patient-focussed information (i.e. patient preferences and background) was poorly presented whilst clinical data (e.g. Radiology) scored higher. The quality of MDT discussion and decision-making from core members was highly variable with surgeons scoring highly compared to specialist nurses. Mean time per patient discussion was 4.46 min (range 1–18 min). Medical notes were unavailable for 73 (21%) of patients.
Conclusion This study demonstrated variability in information provision and discussion from contributing team members. However, a limitation of the rating tool is that a low score is assigned (no contribution) even when no specialty specific contribution is required. This may explain the low scores for Endoscopists and Liver Surgeons, as their expertise was not required for all cases. The MDT tends to focus on 'clinical' discussions and may neglect relevant patient-focussed information. Optimal MDT decision-making requires attention to technical factors (e.g. availability of key information) and non-technical factors such as inclusive discussion, leadership and teamwork skills.
Disclosure of interest None Declared.
Lamb BW, et al. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf.June 2011
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