Decision-making in multidisciplinary cancer teams
Current Projects
Improving the efficacy of Cancer multi-disciplinary team (MDT) decisions
- In the U.K. Cancer care is delivered in the context of Multi-disciplinary team. This concept is expanding to the management of non-cancer patients.
- The aim of MDT meeting discussion is to formulate a management plan for a given cancer patient by the experts. However a decision is not always reached in MDT meetings. Furthermore, not all the decisions made by the MDT, are implemented.
- Barriers to implement these decisions are variable and mostly are related to not considering patient factors during the discussion. The information required for MDT decision making is not always present/ of high quality, which has a negative effect on the quality of decision making.
- The views of all of the members of the MDT are not always included in the decision making process, which has a negative effect on the quality of decision making.
- Training and education are needed for the MDT members however training requirement remains unmet.
Project Aims
- Understand the process of decision making during MDT discussion.
- Explore the barriers to reaching a decision in MDT meetings.
- Develop an intervention to address those barriers and enhance the quality of decision making in cancer MDT meetings and hence a better quality of care.
Methods
A range of exploratory studies (qualitative and quantitative) using mixed methods (interviews, surveys, observations) are used to conduct the proposed research.
Completed Projects
Teamwork and team decision-making in multidisciplinart cancer teams
- Our programme of research into the effect of non-technical and team skills on the quality of multidisciplinary cancer team working is leading international interest in this topic.
- Exploratory studies using mixed methods (interviews, surveys, observations) into facilitators and barriers with healthcare professionals involved in MDT working have helped to define best practice in this field.
- To date, we have developed and validated observational (MDT-MODe) and self-assessment tools, with which MDTs can objectively assess and improve the way the work.
- These tools have gone on to form the basis of ‘MDT-FITT’, a national improvement programme currently undertaken by the Department of Health/National Cancer Action Team to improve and develop MDT working - currently in pilot stage.
- We have also developed a checklist for use in MDT meetings to structure case discussion (MDT-QuIC). Evaluation of this checklist was undertaken using focus groups and an online survey with core MDT members from across the UK who were positive about its use as a tool for the preparation, discussion and recording of case discussions in order to improve clinical decision-making and patient-centeredness in MDT meetings.
- Ongoing studies in this program of research include:
- An 18 month intervention study which has just come to conclusion of quality improvement in a urology MDT. Observational assessment has been ongoing over the duration of the study, and particular issues have been explored in depth with interviews with individual team members. Interventions have included changes to the facilities, equipment, team structure, as well as training interventions, and the introduction of structured proforma (MDT-QuIC) and case preparation. The impact of these changes to teamworking and team decision making of this MDT will be evaluated using multivariate statistical methods.
- An exploration of patient’s views of cancer MDTs. Despite their importance to high quality healthcare, patients’ views on MDT working have hitherto been unexplored. One of our ongoing studies aims to address this by studying patients’ attitudes towards and experiences of MDTs in cancer care, and what patients want from these teams. The results of this project will help to inform the design of the national cancer patients’ survey in 2011/12.
- The research undertaken so far has explored this novel aspect of cancer care and through collaboration between academic, clinical and policy bodies, set the foundation for ongoing and in depth research projects with tangible effects on patients and healthcare professionals.
Project team
- Benjamin Lamb (key contact and Principal Investigator)
- Nick Sevdalis
-
James Green (Whipps Cross University Hospital NHS Trust)
Project team
Collaborators
Project funder
Project start and end dates
May 2009 - Oct 2013
Relevant Links
http://www.whippsx.nhs.uk/en/our-services/clinical/urology.html
http://www.whippsx.nhs.uk/en/research-and-development.html
Resources
Key project outputs
Prizes
- 2nd Prize. Whipps Cross University Hospital NHS Trust Research & Development Day. May 2010
- NHS Influence Award. Poster Prize. National Patient Safety Agency 3rd Annual Patient Safety Research Workshop. December 2009.
Papers
- Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the Cancer Nurse Specialist in the Urology multidisciplinary team meeting. Int J Urol Nursing. In Press
- Lamb B, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making in multidisciplinary cancer conferences: Barriers, facilitators, and opportunities for improvement. World J Surg. DOI 10.1007/s00268-011-1152-1
- Lamb B, Sevdalis N, Mostafid H, Vincent C, Green JSA. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol DOI 10.1245/s10434-011-1773-5.
- Lamb B, Wong H, Vincent C, Green JSA, Sevdalis N. Teamwork and team performance in urological multidisciplinary cancer teams: Development and evaluation of an observational assessment tool. BMJ Qual Saf (2011). doi:10.1136/bmjqs.2010.048660
- Lamb B, Brown K, Nagpal K, Vincent C, Green JSA, Sevdalis, N. Team decision making by cancer care multidisciplinary teams: a systematic review. Annals of Surgical Oncology. 2011 Mar 26. [Epub ahead of print] DOI 10.1245/s10434-011-1675-6
- Lamb B, Sevdalis N, Green J. Re Improving patient safety in urology: An integrated approach to patient safety. BJU Int. 2010 Dec;106(11):1827. doi: 10.1111/j.1464-410X.2010.09928_4.x.
- Lamb B, Sevdalis N. How do nurses make decisions? Int J Nurs Stud. 2010 Nov 9. doi:10.1016/j.ijnurstu.2010.10.003
- Arora S, Lamb B, Undre S, Kneebone R, Darzi A, Sevdalis N. Framework for the incorporation of simulation into urological training. BJU Int. 2010 Sep 24. doi: 10.1111/j.1464-410X.2010.09563.x.
- Lamb B, Sevdalis N, Payne H, Green JSA. A Survey of Attitudes towards Urology MDT meetings among delegates at the British Uro-oncology Group Annual Conference 2009. Bug Bytes. Issue 6, Spring 2010.
- Lamb B, Green JSA, Vincent C, Sevdalis N. Decision making in surgical oncology, Surgical Oncology (2010), doi:10.1016/j.suronc.2010.07.007
- Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C, Moorthy K. Information transfer and Communication in Surgery: A Systematic Review. Annals of Surgery August 2010 252(2), 225-23
- Lamb B, Payne H, Vincent C, Sevdalis N, Green JSA. The role of oncologists in multidisciplinary cancer teams in the UK: An untapped resource for team leadership. Journal of Evaluation in Clinical Practice DOI: 10.1111/j.1365-2753.2010.01507.x
- Lamb B. Quality improvement for doctors- it’s essential. J R Soc Med 102(8): 310
- Lamb B, Nagpal K. Patient safety: Importance of near misses. BMJ 2009;339:b3032
Invited talks
- Lamb B et al. Improving clinical decision-making in multidisciplinary teams. Presidents Day, Urology Section, Royal Society of Medicine. 13th May 2011, London.
- Lamb B. How to improve your MDT. Improving Quality (IQ) Seminar, Hillingdon Hospital. 5th May 2011, London.
- Lamb BW, et al. Report to MDT Coordinators Conference on National Survey Results. Multi Disciplinary Team Co-ordinators Conference, Birmingham, 3rd March 2011.
- Lamb B, Sevdalis N, Green JSA. Important aspects in MDT decision-making: Using a checklist. Prostate Cancer Update 2010 Southern. 11th June 2010, Bristol.
- Lamb B, Sevdalis N, Green JSA. Important aspects in MDT decision-making. Prostate Cancer Update 2010 Northern. 21st May 2010, Manchester.
- Lamb B, Green J. Improving non-clinical aspects of SMDT’s. Pelican Foundation Bladder Cancer SMDT Training programme.
Presentations
- Lamb BW, et al. Does one size of MCC fit all? Comparison of urology with other tumour types. American Urological Association, Washington DC. 14-19th May 2011.
- Lamb B et al. Does one size fit all? Cancer MDT working across different tumour types. Association of Surgeons in Training Annual Conference. 15-17th April 2011, Sheffield.
- Lamb BW, et al. Barriers, facilitators and patient-centeredness in multidisciplinary cancer teams:a qualitative study with a national UK sample. Association of Surgeons in Training Annual Conference. 15-17th April 2011, Sheffield.
- Lamb B, Mostafid H, Green JSA, Sevdalis N. Quality of team-working and leadership in cancer multidisciplinary team meetings: a multi-method investigation. 4th International Workshop: Behavioural Science Applied to Surgery (Sep 13-14 2010, Amsterdam)
- Lamb B, Wong H, Green J, Sevdalis, N. Developing observational measures of performance in cancer multidisciplinary teams. 4th International Workshop: Behavioural Science Applied to Surgery (Sep 13-14 2010, Amsterdam)
- Lamb B, Payne H, Vincent C, Sevdalis N, Green JSA. Leadership Quality in Multidisciplinary Teams for Urological Cancers - Are Uro-oncologists an Untapped Resource? 27th International Conference of the International Society for Quality in Health Care. 12th October 2010.
- Lamb B, Mostafid H, Green JSA, Sevdalis N. Non-technical skills, team-working and quality in urological multidisciplinary cancer teams: a multi-method investigation. 27th International Conference of the International Society for Quality in Health Care. 12th October 2010.
- Lamb B, Brown K, Green J, Sevdalis, N. Decision making in cancer multi-disciplinary teams (MDT’s) - a systematic review. 27th International Conference of the International Society for Quality in Health Care. 12th October 2010.
- Lamb B, Brown K, Green J, Sevdalis, N. Decision making in cancer multi-disciplinary teams- a systematic review. National Patient Safety Agency 3rd Annual Patient Safety Research Workshop.
- Lamb B, Brown K, Green J, Sevdalis, N. Decision making in cancer multi-disciplinary teams- a systematic review. 2nd North British Patient Safety Research Symposium. 6th November 2009, Aberdeen.
