Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
ENT, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
BMJ Open. 2022 Aug 24;12(8):e061654. doi: 10.1136/bmjopen-2022-061654.
To describe how patients are engaged with cancer decisions in the context of multidisciplinary team (MDT) and how MDT recommendations are operationalised in the context of a shared decision.
Ethnographic qualitative study.
Four head and neck cancer centres in the north of England.
Patients with a diagnosis of new or recurrent head and neck cancer; non-participant observation of 35 MDT meetings and 37 MDT clinics, informal interviews, and formal, semistructured interviews with 20 patients and 9 MDT staff members.
Ethnographic methods including non-participant observation of MDT meetings and clinic appointments, informal interviews, field notes and formal semistructured interviews with patients and MDT members.
MDT discussions often conclude with a firm recommendation for treatment. When delivered to a patient in clinic, this recommendation is often accepted by the patient, but this response may result from the disempowered position in which they find themselves. While patient behaviour may thus appear to endorse clinicians' views that a paternalistic approach is desired by patients (creating a 'cycle of paternalism'), the rigidity of the MDT treatment recommendation can act as a barrier to discussion of options and the exploration of patient values.
The current model of MDT decision-making does not support shared decision-making and may actively undermine it. A model should be developed whereby the individual patient perspective has more input into MDT discussions, and where decisions are made on potential treatment options rather than providing a single recommendation for discussion with the patient. Deeper consideration should be given to how the MDT incorporates the patient perspective and/or delivers its discussion of options to the patient. In order to achieve these objectives, a new model of MDT working is required.
描述患者在多学科团队（MDT）背景下如何参与癌症决策，以及 MDT 建议在共享决策背景下如何实施。
民族志定性研究。
英格兰北部的四个头颈部癌症中心。
新诊断或复发性头颈部癌症患者；对 35 次 MDT 会议和 37 次 MDT 诊所进行非参与性观察、非正式访谈以及对 20 名患者和 9 名 MDT 工作人员进行正式半结构式访谈。
民族志方法，包括对 MDT 会议和诊所预约的非参与性观察、非正式访谈、现场记录和对患者和 MDT 成员的正式半结构式访谈。
MDT 讨论通常以对治疗的坚定建议结束。当在诊所向患者传达该建议时，患者通常会接受，但这种反应可能源于他们所处的无权地位。虽然患者的行为似乎认可了临床医生的观点，即患者希望采用家长式方法（造成“家长式循环”），但 MDT 治疗建议的僵化可能会成为讨论选择和探索患者价值观的障碍。
目前的 MDT 决策模式不支持共享决策，甚至可能会对其产生不利影响。应开发一种模式，使个体患者的观点更多地纳入 MDT 讨论，并根据潜在的治疗选择做出决策，而不是向患者提供单一的讨论建议。应更深入地考虑 MDT 如何纳入患者观点，以及如何向患者传达其选择讨论内容。为了实现这些目标，需要一种新的 MDT 工作模式。
