School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.
Cancer Med. 2021 Feb;10(4):1240-1252. doi: 10.1002/cam4.3719. Epub 2021 Jan 21.
Globally, Multidisciplinary Teams (MDTs) are considered the gold standard for diagnosis and treatment of cancer and other conditions, but variability in performance has led to demand for improvement tools. MDT-FIT (Multidisciplinary Team Feedback for Improving Teamwork) is an improvement programme developed iteratively with over 100 MDTs (≥1100 MDT-members). Complex interventions are often adapted to context, but this is rarely evaluated. We conducted a prospective evaluation of the implementation of MDT-FIT across an entire integrated care system (ICS).
MDT-FIT was implemented within all breast cancer MDTs across an ICS in England (n = 10 MDTs; 275 medical, nursing, and administrative members). ICS managers coordinated the implementation across the three stages of MDT-FIT: set up; assessment (self-report by team members plus independent observational assessment); team-feedback and facilitated discussion to agree actions for improvement. Data were collected using process and systems logs, and interviews with a purposively selected range of participants. Analysis was theoretically grounded in evidence-based frameworks for implementation strategies and outcomes.
All 10 MDTs participated in MDT-FIT; 36 interviews were conducted. Data from systems and process logs covered a 9-month period. Adaptations to MDT-FIT by the ICS (e.g., coordination of team participation by ICS rather than individual hospitals; and reducing time protected for coordination) reduced Fidelity and Adoption of MDT-FIT. However, the Acceptability, Appropriateness and Feasibility of MDT-FIT remained high due to embedding implementation strategies in the development of MDT-FIT (e.g., stakeholder engagement, interactive support).
This is a unique and comprehensive evaluation of the multi-site implementation of a complex team improvement programme. Findings support the imperative of considering implementation strategies when designing such programmes to minimize potentially negative impacts of adaptations in "real world" settings.
在全球范围内，多学科团队（MDTs）被认为是癌症和其他疾病诊断和治疗的金标准，但由于绩效的可变性，人们对改进工具的需求不断增加。MDT-FIT（多学科团队反馈以改善团队合作）是一个迭代开发的改进项目，已有超过 100 个 MDT（≥1100 名 MDT 成员）参与其中。复杂的干预措施通常需要根据具体情况进行调整，但这一点很少得到评估。我们对整个综合护理系统（ICS）中 MDT-FIT 的实施情况进行了前瞻性评估。
MDT-FIT 在英格兰 ICS 中的所有乳腺癌 MDT 中实施（n=10 个 MDT；275 名医疗、护理和行政成员）。ICS 经理在 MDT-FIT 的三个阶段协调实施：设置；评估（团队成员的自我报告加独立观察评估）；团队反馈并促进讨论，以商定改进措施。使用过程和系统日志以及有针对性地选择的一系列参与者的访谈收集数据。分析在基于证据的实施策略和结果框架理论上进行。
所有 10 个 MDT 都参与了 MDT-FIT；进行了 36 次访谈。系统和过程日志的数据涵盖了 9 个月的时间。ICS 对 MDT-FIT 的调整（例如，由 ICS 协调团队参与，而不是由个别医院协调；以及减少用于协调的受保护时间）降低了 MDT-FIT 的保真度和采用度。然而，由于在 MDT-FIT 的开发中嵌入了实施策略（例如利益相关者参与、互动支持），MDT-FIT 的可接受性、适当性和可行性仍然很高。
这是对复杂团队改进计划在多个地点实施情况的独特而全面的评估。研究结果支持在设计此类计划时考虑实施策略的必要性，以最小化“真实世界”环境中调整的潜在负面影响。
