Guillem Pascale, Bolla Michel, Courby Stéphane, Descotes Jean-Luc, Laramas Mathieu, Moro-Sibilot Denis
CHU de Grenoble, centre de coordination en cancérologie, France.
Bull Cancer. 2011 Oct;98(9):989-98. doi: 10.1684/bdc.2011.1428.
Resulting medical decision from a multidisciplinary team (MDT) meeting has to be accurate regarding to various patient criteria and relevant specialists participation. The target is to optimize treatment or management options for patients taking into account patients' benefit. The aim of our study was to examine quality criteria of MDT meeting processes, implementation of the MDT decision, and the follow-up of national or regional clinical guidelines. The results lead us to discuss about care management in cancer. Ten various medical specialities of MDT meetings were studied. Relevant multidisciplinarity varied between MDT meetings specialities and was effective between 55 and 100%. Implementation of the decisions that arise from MDT meetings was 86.3%. The most frequent grounds of non-application were patient refusal and new or previous unknown clinical data. The percentage of MDT meetings decisions following national or regional recommendations was 74%. The main reason of not following was the complexity of clinical patient circumstances. Participation in MDT meetings is more and more time-consuming related to enforce the completeness referred to the Plan Cancer (National recommendations). Leading to completeness raises questions about medical time employment and meaning of the MDT meeting for standard clinical cases. The priority seems to enforce multidisciplinarity rather than reach completeness.
多学科团队(MDT)会议做出的医疗决策必须在各种患者标准和相关专家参与方面准确无误。目标是在考虑患者利益的情况下优化患者的治疗或管理方案。我们研究的目的是检查MDT会议流程的质量标准、MDT决策的实施情况以及国家或地区临床指南的遵循情况。研究结果促使我们讨论癌症的护理管理。我们研究了MDT会议的十个不同医学专业。MDT会议各专业之间的相关多学科性有所不同,有效率在55%至100%之间。MDT会议产生的决策实施率为86.3%。最常见的未实施原因是患者拒绝以及新出现或之前未知的临床数据。遵循国家或地区建议的MDT会议决策百分比为74%。未遵循的主要原因是临床患者情况复杂。与执行《癌症计划》(国家建议)所要求的完整性相关,参与MDT会议越来越耗时。实现完整性引发了关于医疗时间利用以及MDT会议对标准临床病例意义的问题。优先事项似乎是加强多学科性而非实现完整性。