Centre for Implementation Science, Health Service & Population Research Department, King's College London, London, UK.
Department of Urology, Cambridge University Hospital NHS Trust, London, UK.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac093.
Multidisciplinary teams (MDTs) are widely used in cancer care. Recent research points to logistical challenges impeding MDT decision-making and dissatisfaction among members. This study sought to identify different types of logistical issues and how they impacted team processes.
This was a secondary analysis of a cross-sectional observational study. Three cancer MDTs (breast, colorectal, and gynaecological) were recruited from UK hospitals. Validated observational instruments were used to measure decision-making (Metrics of Observational Decision-making, MDT-MODe), communication (Bales' Interaction Process Analysis, Bales' IPA), and case complexity (Measure of Case Discussion Complexity, MeDiC), including logistical challenges (Measure of Case Discussion Complexity, MeDiC), across 822 case discussions from 30 videoed meetings. Descriptive analysis and paired samples t tests were used to identify and compare frequency of different types of logistical challenges, along with partial correlations, controlling for clinical complexity of cases, to understand how such issues related to the MDT decision-making and communication.
A significantly higher frequency of administrative and process issues (affecting 30 per cent of cases) was seen compared with the frequency of equipment issues (affecting 5 per cent of cases; P < 0.001) and the frequency of the attendance issues (affecting 16 per cent of cases; P < 0.001). The frequency of the attendance issues was significantly higher than the frequency of equipment issues (P < 0.001). Partial correlation analysis revealed that administrative and process issues, including attendance, were negatively correlated with quality of information (r = -0.15, P < 0.001; r = -0.11, P < 0.001), and equipment issues with the quality of contribution to meeting discussion (r = -0.14, P < 0.001). More questioning and answering by MDT members was evident with the administrative and process issues (r = 0.21, P < 0.001; r = 0.19, P < 0.001). Some differences were observed in teams' socioemotional reactions to the administrative and process issues with the gynaecological MDT showing positive correlation with positive socioemotional reactions (r = 0.20, P < 0.001), and the breast cancer MDT with negative socioemotional reactions (r = 0.17, P < 0.001).
Administrative and process issues were the most frequent logistical challenges for the studied teams. Where diagnostic results were unavailable, and inadequate patient details provided, the quality of decision-making was reduced.
多学科团队（MDTs）在癌症治疗中被广泛应用。最近的研究指出，存在妨碍 MDT 决策制定和团队成员不满的后勤挑战。本研究旨在确定不同类型的后勤问题以及它们如何影响团队流程。
这是一项横断面观察性研究的二次分析。从英国医院招募了三个癌症 MDT（乳腺、结直肠和妇科）。使用经过验证的观察工具测量决策（观察决策度量，MDT-MODe）、沟通（Bales'互动过程分析，Bales'IPA）和病例复杂性（病例讨论复杂性度量，MeDiC），包括后勤挑战（病例讨论复杂性度量，MeDiC），在 30 次视频会议的 822 次病例讨论中。使用描述性分析和配对样本 t 检验来识别和比较不同类型后勤挑战的频率，并进行部分相关分析，控制病例的临床复杂性，以了解这些问题与 MDT 决策制定和沟通的关系。
与设备问题（影响 5%的病例；P<0.001）和出勤问题（影响 16%的病例；P<0.001）相比，行政和流程问题（影响 30%的病例）的频率明显更高。出勤问题的频率明显高于设备问题（P<0.001）。偏相关分析显示，行政和流程问题（包括出勤）与信息质量呈负相关（r=-0.15，P<0.001；r=-0.11，P<0.001），设备问题与会议讨论的贡献质量呈负相关（r=-0.14，P<0.001）。MDT 成员的提问和回答明显增多，行政和流程问题明显增多（r=0.21，P<0.001；r=0.19，P<0.001）。在妇科 MDT 中，对行政和流程问题的社会情感反应呈正相关（r=0.20，P<0.001），而在乳腺癌 MDT 中则呈负相关（r=0.17，P<0.001）。
行政和流程问题是研究团队最常见的后勤挑战。在无法获得诊断结果和提供不充分的患者详细信息的情况下，决策质量会降低。
