Vijayakumar Srinivasan, Lancaster Frances B, Nittala Mary R, Duggar William N
Radiation Oncology, University of Mississippi Medical Center, Jackson, USA.
Cureus. 2023 Jan 11;15(1):e33665. doi: 10.7759/cureus.33665. eCollection 2023 Jan.
Cancer care (CC) is incredibly complex and requires the coordination of multiple disciplines for optimal outcomes. Historically, this has been accomplished with multidisciplinary tumor boards (MDTBs), but the benefits, while perhaps intuitive, have not always been demonstrated with sufficient research robustness and validity. We hypothesize that this difficulty in demonstrating the benefit of MDTBs may be related to a delay in decision-making and operationalizing those decisions. The history and value of MDTBs are presented as well as their weaknesses and limited demonstration of improved outcomes. A major weakness highlighted by the challenges of MDTBs is the concept of total package time (TPT) (rather, the inability to keep it as short as possible); any significant delays in CC for any discipline may have a deleterious impact on any given patient's care outcome. Drawing on our own experience with utilizing information and communication technology (ICT) during an effort to apply accountability theory to improve specifically radiation therapy package time (RTPT), we argue that similar principles will be applicable in the improvement of not only the TPT which relies on multiple disciplines, but other factors of CC as well, such as coordination. Experience with improvement in RTPT is discussed and the underlying theory is demonstrated as a sound methodology to apply beyond RTPT to TPT involving coordination of multiple disciplines and stands to lead to the full realization of the benefits of the multidisciplinary approach. The complexity of cancer means that real solutions to optimal outcomes are also, by nature, complex, but here simple accountability theory is demonstrated that may unlock the next phase of multidisciplinary coordination. In this work, we argue that the benefits of the MDTB format can be fully realized with the addition of ICT, a technological breakthrough in the past two decades, while not forgetting about continued human factors.
癌症护理（CC）极其复杂，需要多学科协作以实现最佳治疗效果。从历史上看，这是通过多学科肿瘤委员会（MDTBs）来完成的，但这些委员会带来的益处，尽管可能直观易懂，但在研究的稳健性和有效性方面，并非总能得到充分证明。我们推测，难以证明MDTBs的益处可能与决策延迟以及决策的实施有关。本文介绍了MDTBs的历史和价值，以及它们的弱点和在改善治疗效果方面的有限证明。MDTBs面临的挑战所凸显的一个主要弱点是总套餐时间（TPT）的概念（确切地说，是无法将其尽可能缩短）；CC过程中任何学科的显著延迟都可能对任何特定患者的护理结果产生有害影响。借鉴我们自己在努力应用问责理论以专门改善放射治疗套餐时间（RTPT）期间利用信息通信技术（ICT）的经验，我们认为类似的原则不仅适用于改善依赖多学科的TPT，也适用于CC的其他因素，如协调。文中讨论了改善RTPT的经验，并证明了其 underlying理论是一种适用于RTPT之外、涉及多学科协调的TPT的合理方法，有望充分实现多学科方法的益处。癌症的复杂性意味着实现最佳治疗效果的真正解决方案本质上也是复杂的，但本文展示了简单的问责理论可能会开启多学科协调的下一阶段。在这项工作中，我们认为，通过添加ICT（过去二十年的一项技术突破），可以充分实现MDTB格式的益处，同时也不能忽视人的因素。
