多学科肿瘤学会议中治疗决策的预测因素：一项定量观察性研究。

Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study.

作者信息

Soukup Tayana, Lamb Benjamin W, Sarkar Somita, Arora Sonal, Shah Sujay, Darzi Ara, Green James S A, Sevdalis Nick

机构信息

Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London, London, UK.

Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK.

出版信息

Ann Surg Oncol. 2016 Dec;23(13):4410-4417. doi: 10.1245/s10434-016-5347-4. Epub 2016 Jul 5.

DOI:10.1245/s10434-016-5347-4

PMID:27380047

Abstract

BACKGROUND

In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review.

METHODS

This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and specialist cancer nurses). The teams' ability to reach a decision was a dichotomous outcome variable (yes/no).

RESULTS

Using multiple logistic regression analysis, the significant positive predictors of the teams' ability to reach a decision were patient psychosocial information (odds ratio [OR] 1.35) and the inputs of surgeons (OR 1.62), radiologists (OR 1.48), pathologists (OR 1.23), and oncologists (OR 1.13). The significant negative predictors were patient comorbidity information (OR 0.83) and nursing inputs (OR 0.87).

CONCLUSIONS

Multidisciplinary inputs into case reviews and patient psychosocial information stimulate decision making, thereby reinforcing the role of MTBs in cancer care in processing such information. Information on patients' comorbidities, as well as nursing inputs, make decision making harder, possibly indicating that a case is complex and requires more detailed review. Research should further define case complexity and determine ways to better integrate patient psychosocial information into decision making.

摘要

背景

在许多医疗保健系统中，癌症患者的治疗建议由多学科肿瘤委员会（MTB）制定。有证据表明，会议中跨学科对病例审查的贡献不均衡，信息共享不理想，生物医学信息比患者合并症和心理社会因素方面的信息占主导地位。本研究旨在评估决策过程的不同要素如何影响团队在首次病例审查时做出决策的能力。

方法

这是一项对2010年至2014年癌症MTB的1045次病例审查进行的观察性定量评估，使用经过验证的工具“决策观察指标”。该工具可评估信息呈现的质量（病史、放射学、病理学和心理社会信息、合并症以及患者观点），以及各个核心专科（外科医生、肿瘤学家、放射科医生、病理学家和专科癌症护士）对讨论的贡献。团队做出决策的能力是一个二分结果变量（是/否）。

结果

使用多元逻辑回归分析，团队做出决策能力的显著正向预测因素是患者心理社会信息（比值比[OR]为1.35）以及外科医生（OR为1.62）、放射科医生（OR为1.48）、病理学家（OR为1.23）和肿瘤学家（OR为1.13）的投入。显著负向预测因素是患者合并症信息（OR为0.83）和护理投入（OR为0.87）。