Wilcoxon Heidi, Luxford Karen, Saunders Christobel, Peterson Janice, Zorbas Helen
National Breast and Ovarian Cancer Centre, Sydney, New South Wales School of Surgery, University of Western Australia, Nedlands, WA, Australia.
Asia Pac J Clin Oncol. 2011 Mar;7(1):34-40. doi: 10.1111/j.1743-7563.2010.01369.x. Epub 2011 Jan 26.
Multidisciplinary care (MDC) is accepted as best practice in cancer treatment planning and care. Despite recognition of the importance of a team approach, limited data are available about the extent to which MDC has been implemented in Australia. The aim of the audit was to investigate the implementation of MDC for five main cancer types across Australia in line with best practice.
A sample of 155 hospitals was surveyed to investigate the status of MDC for cancer treatment planning in Australia across five cancer types (breast, gynecological, lung, prostate and colorectal). The survey investigated team structure, meetings, patient consent, documentation of team recommendations and communication with the patient.
Two-thirds of hospitals surveyed did not have a multidisciplinary team. Of those with such a team; in one-third patients were not informed their case would be discussed by the team, in half patient consent was not sought for all cases discussed by the team, in one-quarter the team's recommended treatment plan was not noted in the patient record. Less than 1% of teams reported routine attendance by the tumour-specific minimum core team.
MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided.
多学科护理（MDC）被公认为癌症治疗规划与护理的最佳实践。尽管认识到团队协作方法的重要性，但关于MDC在澳大利亚的实施程度，可用数据有限。此次审计的目的是根据最佳实践，调查澳大利亚五种主要癌症类型的MDC实施情况。
对155家医院进行抽样调查，以研究澳大利亚五种癌症类型（乳腺癌、妇科癌症、肺癌、前列腺癌和结直肠癌）治疗规划中的MDC状况。该调查涵盖团队结构、会议、患者同意、团队建议的记录以及与患者的沟通。
三分之二接受调查的医院没有多学科团队。在有此类团队的医院中，三分之一的医院未告知患者其病例将由团队讨论，一半的医院在团队讨论的所有病例中未征求患者同意，四分之一的医院未在患者记录中注明团队推荐的治疗方案。不到1%的团队报告特定肿瘤最小核心团队有常规出勤。
MDC在澳大利亚未按照最佳实践实施，也未得到一致应用。尽管有关于MDC的国家建议，但此次审计凸显了护理提供方面的差距。被忽视的领域可能会影响所提供护理的质量，并可能使临床医生面临医疗法律风险。文中提供了提高MDC采用率和有效性的建议。
