Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, Nijmegen, 6500 HB, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, 3511 DT, The Netherlands.
BMC Health Serv Res. 2022 Jun 27;22(1):829. doi: 10.1186/s12913-022-08112-0.
Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs' efficiency, functioning and quality, and offer recommendations for improvement.
Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01-01-1990 to 09-11-2021), using different descriptions of 'MDTM' and 'neoplasm' as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author.
Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs.
MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
在全球癌症护理中，在多学科团队会议（MDTM）中讨论癌症患者是惯例，这需要在资金和时间方面进行大量投资。因此，涉及的所有专业医疗保健提供者之间的高效协作和沟通至关重要。然而，缺乏可以保证 MDTM 高质量运作的循证标准。在这项系统评价中，我们研究了影响 MDTM 效率、功能和质量的因素，并提出了改进建议。
通过搜索 Medline、EMBASE 和 PsycINFO 数据库（1990 年 1 月 1 日至 2021 年 11 月 9 日），使用“MDTM”和“肿瘤”的不同描述作为搜索词，确定了相关研究。纳入标准为：MDTM 质量、MDTM 功能、MDTM 框架和执行、决策过程、教育、患者倡导、患者参与和评估工具。两名作者分别进行全文评估，并由第三名作者进行检查。
74 篇文章符合纳入标准，确定了五个主题：1）MDTM 特征和后勤，2）团队文化，3）决策，4）教育，和 5）评估和数据收集。当会议按计划进行、有结构、所有核心成员都有准备并参加、由合格主席指导并由管理员支持时，MDTM 的质量会提高。需要为每个病例确定适当的时间，并简化病例（即讨论预定选择的病例，而不是讨论每个病例），可能是实现这一目标的一种方式。以患者为中心有助于做出正确的诊断和决策。虽然医生对患者参与自己的 MDTM 持谨慎态度，但大多数患者表示，他们感觉得到了更好的信息，而不会感到焦虑增加。参加 MDTM 会促进医生之间更紧密的工作关系，并提供一些医疗法律保护。为了确保未来 MDTM 运作良好，初级医生应在决策过程中发挥突出作用。已经开发了几种评估工具来评估 MDTM 的功能。
MDTM 可以从更结构化的会议、核心成员的出席，特别是主治医生的出席、简化病例和结构化评估中受益。以患者为中心、MDTM 参与者的个人能力和教育没有得到足够的重视。
