Degrees of Multidisciplinarity Underpinning Care Planning for Patients with Cancer in Weekly Multidisciplinary Team Meetings: Conversation Analysis

Figures & data

Figure 1 Orientation-Discussion-Decision-Implementation (ODDI) Framework of Group Decision-Making.

Notes: Adapted with permission from Forsyth DR. Group Dynamics. US: Jon-David Hague; 2014.⁴³ Reprinted with permission from Soukup T. Socio-cognitive factors that affect decision-making in cancer multidisciplinary team meetings [PhD Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁷

Table 1 Team Composition and Meeting Characteristics Across the Participating Cancer Multidisciplinary Teams

	Breast MDT			Colorectal MDT			Gynecological MDT
	N	M	Min, Max	N	M	Min, Max	N	M	Min, Max
Team composition
Surgeons	4	4	4, 4	4	4	4, 4	4	2	2, 4
Oncologists	2	2	2, 2	2	1	1, 1	2	1	1, 1
Radiologists	2	1	1, 2	2	1	1, 1	3	1	1, 1
Histopathologists	1	1	1, 1	1	1	1, 1	2	1	1, 1
Specialist cancer nurses	5	2	2, 4	5	3	2, 4	2	1	2, 4
Team coordinator	1	1	1	1	1	1	1	1	1, 1
Total	15	11	–	15	11	–	14	7	–
Meeting characteristics
Average number of cases discussed per meeting	26			20			43
Average time per patient (HH:MM:SS)	00:02:25			00:03:20			00:02:30
Average meeting duration (HH:MM:SS)	01:06:00			01:00:00			02:52:00
Study characteristics
Number of hours recorded (HH:MM:SS)	09:57:00			13:40:00			31:30:00
Number of cases discussed	241			185			396
Number of meetings observed	10			10			10

Notes: Adapted with permission from Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁸ and Soukup T, Murtagh G, Bali A, et al. Gaps and overlaps in healthcare team communication: analysis of speech patterns in cancer multidisciplinary meetings. Small Group Res. 2020:1–31.³⁷

Abbreviations: N, total number of MDT members; M, average number of MDT members in attendance; Min, Max, minimum and maximum number of MDT members in attendance.

Table 2 Frequency of Adherence by Core Disciplines to the Orientation-Discussion-Decision-Implementation Framework of Group Decision-Making

Core Discipline*	N	ODDI Framework of Group Decision-Making
		Orientation (% of cases)	Discussion (% of cases)	Decision (% of cases)	All stages consistently (% of cases)
Surgeon	12	83	83	88	83
Oncologist	6	13	42	21	8
Radiologist	7	0	58	0	0
Histopathologist	4	0	71	0	0
Cancer Nurse Specialist	12	4	46	0	0
MDT Coordinator	3	0	4	0	0
Case-reviews*	24	96	100	92	88

Notes: *Across all three cancer teams combined (colorectal, breast, and gynecological cancer MDTs). ODDI=Orientation-Discussion-Decision-Implementation; % values rounded to nearest integer for ease of reading. Reprinted with permission from Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁸

Table 3 Multidisciplinary Interaction Formats Underpinning Case-Reviews in Breast, Colorectal, and Gynecological Cancer Multidisciplinary Team Meetings Together with the Frequency of the Formats Across 24 Case Reviews

3A. Breast Cancer Multidisciplinary Team

Surgeon-Oncologist-Led Decision-Making (62%)

Surgeon-Led Decision-Making (38%)

Disciplinary-triad (13%)

Disciplinary-tetrad (38%)

Multi-disciplinary (13%)

Disciplinary-triad (13%)

Disciplinary-tetrad (25%)

Case 2

Orientation: S Discussion: O-P-S Decision: S-O

Case 6

Orientation: O Discussion: O-S-P-R Decision: S-O

Case 12

Orientation: S Discussion: O-S-P-R-N Decision: O-S

Case 16

Orientation: S Discussion: O-P-S Decision: S

Case 8

Orientation: S Discussion: R-P-S-N Decision: S

Case 20

Orientation: O Discussion: O-S-P-R Decision: S

Case 15

Orientation: S Discussion: R-P-S-N Decision: S

Case 10

Orientation: -* Discussion: O-S-P-N Decision: S-O

3B. Colorectal cancer multidisciplinary team

Surgeon-led decision-making (100%)

Disciplinary-dyad (13%)

Disciplinary-triad (38%)

Disciplinary-tetrad (38%)

Multi-disciplinary (13%)

Case 13

Orientation: S Discussion: S-R Decision: S

Case 2

Orientation: S Discussion: S-R-N Decision: S

Case 3

Orientation: S Discussion: S-P-N-C Decision: S

Case 12

Orientation: S Discussion: S-P-N-R-O Decision: S

Case 4

Orientation: S Discussion: S-R-P Decision: S

Case 5

Orientation: S Discussion: S-P-N-R Decision: S

Case 14

Orientation: N-S Discussion: S-R-N Decision: S

Case 11

Orientation: S Discussion: S-P-N-R Decision: S

3C. Gynaecological cancer multidisciplinary team

Surgeon-led decision-making (87.5%)

Oncologist-led decision-making (12.5%)

Disciplinary-dyad (63%)

Disciplinary-triad (13%)

Disciplinary-tetrad (13%)

Disciplinary-triad (25%)

Case 1

Orientation: S Discussion: S-P Decision: S

Case 45

Orientation: S Discussion: S-R-O Decision: S

Case 37

Orientation: S Discussion: S-R-O-N Decision: not named*

Case 26

Orientation: O Discussion: O-R-S Decision: O

Case 27

Orientation: S Discussion: S-P Decision: S

Case 2

Orientation: S Discussion: S-P Decision: S

Case 4

Orientation: S Discussion: S-P Decision: not named*

Case 5

Orientation: S Discussion: S-P Decision: S

Notes: *Not named/announced to the team. Disciplinary-triad=interaction between three core disciplines. Disciplinary-tetrad=interaction between four core disciplines. Multidisciplinary=interaction between five or more core disciplines. One person per discipline was engaged in each case. Reprinted with permission from Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁸

Abbreviations: S, surgeon; R, radiologist; P, pathologist; N, cancer nurse specialist; O, oncologist.

Table 4 Multidisciplinary Interaction Formats Across Teams and Case-Reviews

Team	Disciplinary Engagement*	Disciplinary Interaction Format				Overall
		Dyad	Triad	Tetrad	Multi
Breast	Surgeon-led	-	13%	25%	-	38%
	Oncologist-led	-	-	-	-	-
	Surgeon-Oncologist-led	-	13%	38%	13%	63%
	Overall	-	25%	63%	13%	100%
Colorectal	Surgeon-led	13%	38%	38%	13%	100%
	Oncologist-led	-	-	-	-	-
	Surgeon-Oncologist-led	-	-	-	-	-
	Overall	13%	38%	38%	13%	100%
Gynaecological	Surgeon-led	63%	13%	12.5%	-	88%
	Oncologist-led	-	13%	-	-	13%
	Surgeon-Oncologist-led	-	-	-	-	-
	Overall	63%	25%	13%	-	100%
Overall	Surgeon-led	25%	21%	25%	4%	75%
	Oncologist-led	-	4%	-	-	4%
	Surgeon-Oncologist-led	-	4%	13%	4%	21%
	Overall	25%	29%	38%	8%	100%

Notes: N=24 patients. *Disciplines that consistently engage in all stages of the orientation-discussion-decision-implementation (ODDI) framework and therefore lead/dominate a case-review. In bold are the highest percentages. Reprinted with permission from Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁸

Box 1 Interaction Formats Underpinning Decision-Making in Multidisciplinary Meetings of the Respective Three Teams (Gynecological, Breast, and Colorectal Cancer MDTs) Together with the Frequency of the Formats Across 24 Case-Reviews

A. Single-Discipline Led Case-Reviews (67%)

Style A1. Surgeon presented the patient case, discussion ensued within a disciplinary dyad, triad, tetrad or (the least common) multidisciplinary, surgeon made and stated the decision, 62%

Style A2. Oncologist presented the case, discussion ensued within a disciplinary tetrad, oncologist made and stated the decision, 4%

B. Dual-discipline led case-reviews (21%)

Style B3. Surgeon presented the case, discussion ensued within a disciplinary triad, oncologist and surgeon made and stated the decision, 8%

Style B4. Oncologist presented the case, discussion ensued within a disciplinary tetrad, surgeons and oncologist made and stated the decision, 4%

Style B5. Oncologist presented the case, multidisciplinary discussion ensued, surgeon makes and stated the decision, 4%

Style B6. Surgeon and CNS presented the case, discussion ensued within a triad, surgeon made and stated the decision, 4%

C. Incomplete decision-making process (13%)

Style C7. No case presentation, discussion ensued within a disciplinary tetrad, surgeon and oncologist made the decision, 4%

Style C8. Surgeon presented the case, discussion ensued within a tetrad, decision was not stated verbally to the team, 8%

Notes: Adapted with permission from Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.³⁸

Forsyth DR. Group Dynamics. US: Jon-David Hague; 2014.

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Soukup T. Socio-Cognitive Factors That Affect Decision-Making in Cancer Multidisciplinary Team Meetings [Phd Thesis; Clinical Medicine Research]. London, UK: Imperial College London; 2017.

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Jefferson G. Glossary of transcript symbols with an introduction. In: Lerner GH, editor. Conversation Analysis: Studies from the First Generation (Pp.13–31). John Benjamins Pub Co; 2004.

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