University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
Breast J. 2012 Sep;18(5):459-63. doi: 10.1111/j.1524-4741.2012.01270.x. Epub 2012 Jul 10.
Multi-disciplinary teams (MDTs) management of patients with cancer is mandatory in the United Kingdom, and auditing team decision-making by examining rates of decision implementation and reasons for nonimplementation may inform this practice. Consecutive breast cancer MDT decisions, subsequent decision implementation, and reasons for nonimplementation were prospectively recorded. Factors associated with nonimplementation of the MDT decision were analyzed with logistic regression. Of 289 consecutive MDT decisions involving 210 women, 20 (6.9%, 95% CIs 4.3%-10.5%) were not implemented. Most changed MDT decisions did so because of patient preferences (n = 13, 65%), with the discovery of new clinical information (n = 3) and individual doctor's views (n = 4) also leading to decision nonimplementation. MDT decisions were significantly less likely to be adhered to in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001) and MDT decisions in older patients were significantly more likely not to be implemented than in younger patients (p = 0.002). Auditing nonimplementation of MDT recommendations and examining reasons for changed decisions is a useful process to monitor team performance and to identify factors that need more attention during the MDT meeting to ensure that the process makes optimal patient centered decisions.
多学科团队（MDTs）管理癌症患者在英国是强制性的，通过检查决策实施率和未实施的原因来审核团队决策可以为这种实践提供信息。前瞻性地记录连续的乳腺癌 MDT 决策、随后的决策实施以及未实施的原因。使用逻辑回归分析与未实施 MDT 决策相关的因素。在 289 例连续的 MDT 决策中，涉及 210 名女性，有 20 例（6.9%，95%置信区间 4.3%-10.5%）未实施。大多数改变的 MDT 决策是因为患者的偏好（n=13，65%），新的临床信息（n=3）和个别医生的观点（n=4）也导致了决策的未实施。与良性或“未知”疾病类别的患者相比，确诊恶性疾病患者的 MDT 决策明显更不可能被遵循（p<0.001），年龄较大的患者的 MDT 决策明显更不可能被实施，而年龄较小的患者（p=0.002）。审核 MDT 建议的未实施情况并检查更改决策的原因是一种有用的过程，可以监测团队绩效并确定在 MDT 会议期间需要更多关注的因素，以确保该过程做出最佳的以患者为中心的决策。
