Using peer observers to assess the quality of cancer multidisciplinary team meetings: a qualitative proof of concept study

Abstract

Background

Multidisciplinary team (MDT) working is well established as the foundation for providing cancer services in the UK and elsewhere. A core activity is the weekly meeting (or case conference/tumor boards) where the treatment recommendations for individual patients are agreed. Evidence suggests that the quality of team working varies across cancer teams, and this may impact negatively on the decision-making process, and ultimately patient care. Feedback on performance by expert observers may improve performance, but can be resource-intensive to implement. This proof of concept study sought to: develop a structured observational assessment tool for use by peers (managers or clinicians from the local workforce) and explore its usability; assess the feasibility of the principle of observational assessment by peers; and explore the views of MDT members and observers about the utility of feedback from observational assessment.

Methods

For tool development, the content was informed by national clinical consensus recommendations for best practice in cancer MDTs and developed in collaboration with an expert steering group. It consisted of ten subdomains of team working observable in MDT meetings that were rated on a 10-point scale (very poor to very good). For observational assessment, a total of 19 peer observers used the tool (assessing performance in 20 cancer teams from four hospitals). For evaluation, telephone interviews with 64 team members and all peer observers were analyzed thematically.

Results

The tool was easy to use and areas for refinement were identified. Peer observers were identified and most indicated that undertaking observation was feasible. MDT members generally reported that observational assessment and feedback was useful, with the potential to facilitate improvements in team working.

Conclusion

This study suggests that observation and feedback by peers may provide a feasible and acceptable approach to enhance MDT performance. Further tool refinement and validation is required.

Keywords:

• cancer
• multidisciplinary team
• team working
• observational assessment

Acknowledgments

We would like to thank the team members and observers who participated in this research, and the trust personnel who facilitated their involvement; other affiliate members of Green Cross Medical Ltd who have supported this work; and the National Cancer Action Team MDT Development steering group and subcommittee members for their input and comments. This work was supported in part by the National Cancer Action Team. NS is affiliated with the Imperial Patient Safety Translational Research Centre (http://www.cpssq.org), which is funded by the National Institute for Health Research. We would also like to thank Dr Katrina Brown for research assistance, and Dr Louise Hull and Miss Ruth Collins for assisting with the content analysis.

Disclosure

JSAG has received funding from the National Cancer Action Team for the development of a team training/feedback system for cancer MDTs through Green Cross Medical Ltd. NS has been a paid advisor to Green Cross Medical Ltd. CT and JH were funded for this work through a subcontract between King’s College London and Green Cross Medical Ltd.