Walraven Janneke E W, Verhoeven Rob H A, van der Hoeven Jacobus J M, van der Meulen Renske, Lemmens Valery E P P, Hesselink Gijs, Desar Ingrid M E
Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands.
Front Oncol. 2023 May 18;13:1178165. doi: 10.3389/fonc.2023.1178165. eCollection 2023.
Nowadays nearly every patient with cancer is discussed in a multidisciplinary team meeting (MDTM) to determine an optimal treatment plan. The growth in the number of patients to be discussed is unsustainable. Streamlining and use of computerised clinical decision support systems (CCDSSs) are two major ways to restructure MDTMs. Streamlining is the process of selecting the patients who need to be discussed and in which type of MDTM. Using CCDSSs, patient data is automatically loaded into the minutes and a guideline-based treatment proposal is generated. We aimed to identify the pros and cons of streamlining and CCDSSs.
Semi-structured interviews were conducted with Dutch MDTM participants. With purposive sampling we maximised variation in participants' characteristics. Interview data were thematically analysed.
Thirty-five interviews were analysed. All interviewees agreed on the need to change the current MDTM workflow. Streamlining suggestions were thematised based on standard and complex cases and the location of the MDTM (i.e. local, regional or nationwide). Interviewees suggested easing the pressure on MDTMs by discussing standard cases briefly, not at all, or outside the MDTM with only two to three specialists. Complex cases should be discussed in tumour-type-specific regional MDTMs and highly complex cases by regional/nationwide expert teams. Categorizing patients as standard or complex was found to be the greatest challenge of streamlining. CCDSSs were recognised as promising, although none of the interviewees had made use of them. The assumed advantage was their capacity to generate protocolised treatment proposals based on automatically uploaded patient data, to unify treatment proposals and to facilitate research. However, they were thought to limit the freedom to deviate from the treatment advice.
To make oncological MDTMs sustainable, methods of streamlining should be developed and introduced. Physicians still have doubts about the value of CCDSSs.
如今，几乎每一位癌症患者都会在多学科团队会议（MDTM）上进行讨论，以确定最佳治疗方案。待讨论患者数量的增长是不可持续的。简化流程和使用计算机化临床决策支持系统（CCDSSs）是重组MDTM的两种主要方式。简化流程是指选择需要讨论的患者以及确定在何种类型的MDTM中讨论的过程。使用CCDSSs时，患者数据会自动录入会议记录，并生成基于指南的治疗建议。我们旨在确定简化流程和CCDSSs的优缺点。
对荷兰MDTM的参与者进行了半结构化访谈。通过目的抽样，我们使参与者的特征差异最大化。对访谈数据进行了主题分析。
分析了35次访谈。所有受访者都认同需要改变当前的MDTM工作流程。简化流程的建议根据标准病例和复杂病例以及MDTM的地点（即本地、区域或全国范围）进行了主题分类。受访者建议通过简要讨论标准病例、根本不讨论或仅与两三位专家在MDTM之外讨论来减轻MDTM的压力。复杂病例应在特定肿瘤类型的区域MDTM中讨论，高度复杂的病例则由区域/全国专家团队讨论。将患者分类为标准病例或复杂病例被认为是简化流程的最大挑战。CCDSSs被认为很有前景，尽管没有一位受访者使用过它们。其假定的优势在于能够根据自动上传的患者数据生成标准化治疗建议，统一治疗建议并促进研究。然而，人们认为它们会限制偏离治疗建议的自由度。
为使肿瘤学MDTM可持续发展，应开发并引入简化流程的方法。医生们对CCDSSs的价值仍存疑虑。
