Al-Hammouri Tarek, Almeida-Magana Ricardo, Soukup Tayana, Lamb Benjamin
Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Department of Urology, The Specialty Hospital, Amman, Jordan.
Front Health Serv. 2024 Mar 12;4:1340320. doi: 10.3389/frhs.2024.1340320. eCollection 2024.
In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.
2020年1月，英国国家医疗服务体系（NHS）英格兰和NHS改进部门发布了一个宽松框架，用于简化癌症多学科（MDT）会议流程。简化被定义为一个过程，即复杂病例在MDT会议（MDM）中被优先安排进行充分讨论，而简单病例的管理则通过护理标准（SoC）来加快处理。SoC是患者管理路径中的一些节点，在这些节点上有公认的指南以及关于管理选项的明确临床共识，并且应由地区癌症联盟在区域内达成一致并统一应用。虽然这份报告标志着自1995年卡尔曼 - 海因报告以来癌症MDT管理的首次重大变革，但其在全国范围内的实施进展缓慢，自发布以来已近四年。然而，有人认为简化是确保MDT流程可行性的必要步骤，因此在当前工作量增加、癌症发病率上升、经济压力和劳动力短缺的社会经济背景下，对于维持患者护理至关重要。在这篇小型综述中，我们简要总结了2020年简化框架实施方面的最新进展，包括实施过程中的挑战和障碍，以及该领域未来可能的方向，我们建议应增加实施科学的应用。我们得出结论，要确保框架和SoC的成功实施，需要关键利益相关者的支持，包括MDT和医院管理团队，明确界定（a）管理方法，包括分诊（例如通过小型MDT会议），（b）病例复杂性评估（这直接影响SoC），以及（c）MDT负责人和成员的角色，同时认识到如果不考虑各团队和医院信托之间的个体差异，SoC无法普遍应用。
