Department of Surgery and Cancer, Imperial College London, London, UK.
Ann Surg Oncol. 2011 Aug;18(8):2116-25. doi: 10.1245/s10434-011-1675-6. Epub 2011 Mar 26.
Factors that affect the quality of clinical decisions of multidisciplinary cancer teams (MDTs) are not well understood. We reviewed and synthesised the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making.
Electronic databases were searched in May 2009. Eligible studies reported original data, quantitative or qualitative. Data were extracted and tabulated by two blinded reviewers, and study quality formally evaluated.
Thirty-seven studies were included. Study quality was low to medium. Studies assessed quality of care decisions via the effect of MDTs on care management. MDTs changed cancer management by individual physicians in 2-52% of cases. Failure to reach a decision at MDT discussion was found in 27-52% of cases. Decisions could not be implemented in 1-16% of cases. Team decisions are made by physicians, using clinical information. Nursing personnel do not have an active role, and patient preferences are not discussed. Time pressure, excessive caseload, low attendance, poor teamworking and lack of leadership lead to lack of information and deterioration of decision-making. Telemedicine is increasingly used in developed countries, with no detriment to quality of MDT decisions.
Team/social factors affect management decisions by cancer MDTs. Inclusion of time to prepare for MDTs into team-members' job plans, making team and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings. These improvements ought to be considered at national policy level, with the ultimate aim of improving cancer care.
影响多学科癌症团队（MDT）临床决策质量的因素尚不清楚。我们回顾和综合了影响 MDT 临床决策质量的临床、社会和技术因素的证据。
2009 年 5 月对电子数据库进行了搜索。合格的研究报告了原始数据，定量或定性。由两名盲审员提取和制表数据，并对研究质量进行正式评估。
共纳入 37 项研究。研究质量为低至中等。研究通过 MDT 对护理管理的影响来评估护理决策的质量。MDT 在 2-52%的情况下改变了个别医生的癌症治疗。在 27-52%的情况下，MDT 讨论未能做出决定。在 1-16%的情况下，无法实施决定。团队决策由医生根据临床信息做出。护理人员没有积极的作用，也不讨论患者的偏好。时间压力、工作量过大、出勤率低、团队合作不佳以及缺乏领导力导致信息不足和决策恶化。远程医疗在发达国家越来越多地使用，但不会对 MDT 决策的质量造成损害。
团队/社会因素影响癌症 MDT 的管理决策。将准备 MDT 的时间纳入团队成员的工作计划中，为团队成员提供团队和领导技能培训，并由护理人员系统地参与，可以解决当前的一些不足之处。这些改进应该在国家政策层面上进行考虑，最终目的是改善癌症护理。
