Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom.
Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, United Kingdom.
Oncol Res Treat. 2020;43(3):70-77. doi: 10.1159/000504260. Epub 2019 Nov 19.
Multidisciplinary team (MDT) meetings are widely used across the UK to provide expert decisions and improve cancer outcomes. However, little is known about the underlying mechanisms of MDT decision-making. We investigated how decisions are made regarding the management of advanced ovarian cancer in gynaecological oncology MDT meetings.
A cross-sectional observational study was performed, focussing on 41/ 223 MDT case discussions across six hospitals. The validated MDT-MODe tool was adapted to increase relevance to gynaecological oncology. Case information and contributions from seven disciplines were rated on a five-point Likert scale. Spearman's correlation investigated relationships between factors and an exploratory factor analysis examined the underlying structure of MDT discussion.
Forty-one MDT decisions were made for patients with FIGO Stage III/IV ovarian cancer. MDT case discussions were structured by four factors: "Clinical Presentation," "Patient Factors," "Chair's Direction" and "Input from Other Specialties." Nurses were often quiet but facilitated discussion of patient factors. Junior doctors were not involved in MDT decision-making.
The decision-making process in MDT meetings is driven by four underlying factors, the most significant of which represents patient history, tumour markers, images and radiologist input. Patient factors were underrepresented, and nurses should be empowered to overcome this.
多学科团队（MDT）会议在英国被广泛用于提供专家决策，以改善癌症治疗效果。然而，对于 MDT 决策的潜在机制知之甚少。我们研究了妇科肿瘤 MDT 会议中如何做出关于晚期卵巢癌管理的决策。
本研究进行了一项横断面观察性研究，聚焦于六家医院的 223 次 MDT 病例讨论中的 41 次。我们对经过验证的 MDT-MODe 工具进行了改编，以增加其与妇科肿瘤学的相关性。病例信息和来自七个学科的贡献以五分制李克特量表进行评分。Spearman 相关分析用于研究因素之间的关系，探索性因素分析则用于研究 MDT 讨论的潜在结构。
为FIGO 分期 III/IV 期卵巢癌患者做出了 41 次 MDT 决策。MDT 病例讨论由四个因素构成：“临床表现”、“患者因素”、“主席指导”和“其他专业的意见”。护士通常较为安静，但有助于讨论患者因素。初级医生并未参与 MDT 决策。
MDT 会议中的决策过程受四个潜在因素驱动，其中最重要的是患者病史、肿瘤标志物、图像和放射科医生的意见。患者因素代表性不足，应赋予护士权力来克服这一问题。
