Ung Kim Ann, Campbell Belinda A, Duplan Danny, Ball David, David Steven
Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Asia Pac J Clin Oncol. 2016 Jun;12(2):e298-304. doi: 10.1111/ajco.12192. Epub 2014 Mar 27.
Multidisciplinary team (MDT) meetings are increasingly regarded as a component of multidisciplinary cancer care. We aimed to prospectively measure the impact of MDT meetings on clinicians' management plans for lung oncology patients, and the implementation rate of the meeting recommendations.
Consecutive patient cases presented at the weekly lung oncology MDT meetings were prospectively enrolled. Investigators compared the clinicians' management plans pre-meeting with the consensus plans post-meeting. The meeting was considered to have an impact on management plans if ≥1 of the following changes were detected: tumor stage, histology, treatment intent or treatment modality, or if additional investigations were recommended. Investigators reviewed hospital patient records at 4 months to determine if the meeting recommendations were implemented. Reasons for non-implementation were also recorded.
Of the 55 eligible cases, the MDT meeting changed management plans in 58% (CI 45-71%; P < 0.005). These changes included: additional investigations (59%), or changes in treatment modality (19%), treatment intent (9%), histology (6%) or tumor stage (6%). The meeting recommendations were implemented in 72% of cases. Reasons for non-implementation included deteriorating patient performance status, clinician's preference, the influence of new clinical information obtained after the meeting or patient decision.
MDT meetings significantly impact on the management plans for lung oncology patients. The majority of MDT recommendations (72%) were implemented into patient care. These findings provide further evidence to support the role of MDT meetings as an essential part of the decision-making process for the optimal multidisciplinary management of patients with cancer.
多学科团队(MDT)会议越来越被视为多学科癌症护理的一个组成部分。我们旨在前瞻性地评估MDT会议对肺癌患者临床医生管理计划的影响,以及会议建议的实施率。
前瞻性纳入每周肺癌MDT会议上呈现的连续患者病例。研究人员将会议前临床医生的管理计划与会议后的共识计划进行比较。如果检测到以下≥1项变化,则认为会议对管理计划有影响:肿瘤分期、组织学、治疗意图或治疗方式,或者是否建议进行额外检查。研究人员在4个月时查阅医院患者记录,以确定会议建议是否得到实施。未实施的原因也进行了记录。
在55例符合条件的病例中,MDT会议改变了58%的管理计划(置信区间45 - 71%;P < 0.005)。这些变化包括:额外检查(59%)、治疗方式改变(19%)、治疗意图改变(9%)、组织学改变(6%)或肿瘤分期改变(6%)。会议建议在72%的病例中得到实施。未实施的原因包括患者表现状态恶化、临床医生的偏好、会议后获得的新临床信息的影响或患者的决定。
MDT会议对肺癌患者的管理计划有显著影响。大多数MDT建议(72%)被纳入患者护理。这些发现为支持MDT会议作为癌症患者最佳多学科管理决策过程重要组成部分的作用提供了进一步证据。