Rankin Nicole M, Lai Michelle, Miller Danielle, Beale Philip, Spigelman Allan, Prest Gabrielle, Turley Kim, Simes John
Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, New South Wales, Australia.
Cancer Services, Sydney Local Health District, Sydney, New South Wales, Australia.
Asia Pac J Clin Oncol. 2018 Feb;14(1):74-83. doi: 10.1111/ajco.12765. Epub 2017 Sep 26.
Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre.
We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics.
Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients.
MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence.
多学科护理被倡导为癌症护理的最佳实践。在澳大利亚，关于多学科团队（MDT）会议的运作、决策以及使用证据支持决策的记录相对较少。这项描述性研究旨在考察悉尼催化转化癌症研究中心成员机构的MDT团队的运作、团队会议的作用以及证据的使用情况。
我们设计了一份包含40个项目的结构化调查问卷，主题涵盖会议目的、组织、资源和文档记录；病例负荷估计；证据的使用和质量保证；患者参与和支持性护理需求；以及关于MDT优势和劣势的开放式问题。通过电子邮件邀请参与者，并在线进行调查。使用描述性和比较性统计方法分析数据。
来自七家医院的37个MDT团队参与了调查（回复率100%），代表了常见肿瘤组（70%）和罕见肿瘤组（30%）。MDT会议的目的被报告为治疗（100%）、诊断决策（88%）或教育目的（70%）。大多数MDT团队基于团队共识（92%）、遵循临床实践指南（57%）或其他循证医学来源（33%）做出治疗决策。大多数MDT团队在每次会议上只讨论一部分新患者，强调了针对其他病例进行教育的重要性。在获取数据以进行循证实践的审核和反思方面存在障碍。MDT的优势包括协作以及对患者的高质量讨论。
MDT会议侧重于治疗决策，团队共识在将指南中的研究证据转化为临床决策方面发挥着重要作用。由于每次MDT会议讨论的患者比例不同，对多学科护理进行更广泛的审核将能够更准确地评估治疗建议是否符合最佳实践证据。
