Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
Health Resources and Service Administration, Division of Maternal Child Workforce Development, Department of Health and Human Services, Rockville, Maryland.
Cancer. 2018 Sep 15;124(18):3656-3667. doi: 10.1002/cncr.31394. Epub 2018 Sep 14.
Multidisciplinary treatment planning (MTP) is a process of engaging multiple disciplines to develop or refine the disease management plan. It is widely implemented in US cancer treatment settings and is considered to have favorable effects on both care quality and other outcomes. However, evidence reviews to date regarding MTP effectiveness have based their conclusions on studies conducted predominantly outside the United States. The authors conducted a systematic review of US-based studies to synthesize and critically appraise evidence of the effects of MTP on cancer care quality, health services outcomes, and survival. Database searches identified studies of MTP outcomes conducted in US cancer care settings from 2000 to 2017. Forty-five studies met criteria for inclusion. MTP was associated with favorable effects on several indicators of cancer care quality, including delivery of guideline-concordant treatment and improvements in diagnostic accuracy, staging completeness, surgical technique, and timeliness. Effects on survival and clinical trials enrollment were mixed. Delivery formats for MTP were generally not well described, and study designs were nonrandomized, limiting the ability to identify mediators of intervention effects. Continued study is warranted to clarify effective components of MTP interventions, and to understand the mechanism(s) through which MTP produces favorable effects on outcomes.
多学科治疗计划(MTP)是一种让多个学科参与制定或完善疾病管理计划的过程。它在美国癌症治疗环境中得到广泛应用,被认为对护理质量和其他结果都有积极影响。然而,迄今为止关于 MTP 效果的证据审查都是基于主要在美国以外进行的研究得出的结论。作者对基于美国的研究进行了系统回顾,以综合和批判性评估 MTP 对癌症护理质量、卫生服务结果和生存的影响的证据。数据库搜索确定了 2000 年至 2017 年在美国癌症治疗环境中进行的 MTP 结果研究。有 45 项研究符合纳入标准。MTP 与癌症护理质量的几个指标的有利影响有关,包括提供符合指南的治疗以及提高诊断准确性、分期完整性、手术技术和及时性。对生存和临床试验参与的影响是混合的。MTP 的实施方式通常没有很好地描述,研究设计是非随机的,限制了确定干预效果中介因素的能力。有必要继续研究,以阐明 MTP 干预的有效成分,并了解 MTP 对结果产生有利影响的机制。