The Next Step Toward Patient-Centeredness in Multidisciplinary Cancer Team Meetings: An Interview Study with Professionals

Figures & data

Table 1 MDT Members’ Characteristics (n = 24)

	Characteristic	Total
MDT – N
	Gastroenterology	8
	Gynecology	4
	Urology	2
	Head and neck	3
	Hematology	7
Discipline – N
	Hematologic oncologist	6
	Medical oncologist	2
	Radiation oncologist	3
	Head and neck surgical oncologist	3
	Gastrointestinal surgical oncologist	2
	Gynecological surgical oncologist	3
	Urological surgical oncologist	1
	Gastroenterologist	1
	Nurse practitioner	3
Age range – yr.		29–63
Gender – N
	Male	10
	Female	14

Abbreviation: MDT, multidisciplinary cancer team.

Table 2 MDT Case Discussion Characteristics

MDT	Total Cases (Number)	Average Duration and Range of Case Discussion (min:sec)	Average Participating Clinicians (n)	More Than One Treatment Option Discussed (%)	Use of Non- Medical Information (%)
Gastroenterology	24	4:43 (1:20–11:30)	6	35	29
Gynecology	28	2:58 (1:00–6:40)	4	18	18
Urology	22	4:08 (0:50–14:10)	5	39	18
Head and neck	31	5:30 (2:05–11:10)	7	15	6
Hematology	24	4:41 (1:10–10:25)	4	43	25
Total	129	4:25 (0:50–14:10)	5	27	19

Abbreviation: MDT, multidisciplinary cancer team.

Table 3 Overview of Needs for Patient-Centeredness

Category	Subcategory
Information in the MDT meeting	Need for patient-centered information
	Need for knowing goals and preferences
	Need for individualized information.
Decision-making	Need for patient-centeredness in consultation with the patient
	Need for patient-centeredness during MDT decision-making process
	Resistance to more patient-centeredness
Information following the MDT meeting	Need for more information following MDT meeting
	Need to register/document information
	Need to discuss information with the patient

Abbreviation: MDT, multidisciplinary cancer team.

Table 4 Overview of Strategies to Improve Patient-Centeredness

Category	Subcategory	Strategy	Corresponding Need
Organization	People management	Involve staff with an attention to patient-centered information (nurse, psychologist, social worker, geriatrician, general practitioner, clinician familiar with patient). Delegate goal clarification to general practitioner.^a Attendance of clinician who is familiar with the patient.	Patient-centered information. Knowing goals and preferences. Individualized information.
	Information management	Show picture of patient on screen.^a Enable teleconferencing for eg general practitioner, physician from referring hospital.^a	Patient-centered information. Individualized information.
	Meeting management	Organize more or longer MDT meetings to relieve time pressure.^a Guarantee adequate MDT preparation time for physician in charge of patient. Introduce structured patient presentation. Guarantee access to patient information timely before MDT meeting, also with referrals. Oblige completing patient file before MDT meeting. Chair is responsible for patient-centeredness. Co-chair with secretary role. Chair works following strict principles.	-
	Education	Train MDT on Shared Decision-Making (SDM).^a Train chair for patient-centeredness.^a Exchange best practices between MDTs. Teach patient-centeredness to interns/residents. Teach chairing task to interns/residents.	-
Decision-making	MDT process	Select patients for detailed discussion or short discussion. Discuss alternative treatments with pros and cons.^a Case close off with recommendation, arguments/rationale, and level of agreement.^a Do not aim for consensus in complex cases, but eg, provide a list with options.^a Postpone decision to next meeting in referral patients instead of giving a conditional advice.	Patient-centeredness during MDT decision-making process.
	Patient process	Elicit patient values, preferences, and goals with tools.^a Make asking values, preferences, and goals a routine. Use decision aid.^a Support of GP to clarify values.^a Invite the patient to MDT meeting,^a or have two consecutive meetings with and without patient.	Patient-centeredness in consultation with the patient. Patient-centered information. Knowing goals and preferences. Individualized information. To discuss information with the patient.
	Patient advocacy	Assign a patient advocate (nurse, GP, physician in charge).^a Define the role of the patient advocate, eg to present the patient, to clarify the values, to ask patient-centered information, to advocate the patient’s opinion.	Patient-centered information. Knowing goals and preferences.
Communication	Information to MDT	Presence of professional with info, eg, nurse, assistant, general practitioner, physician in charge, geriatrician. Standardize collection of patient-centered information or individualized medical information by: - Questionnaire, tool, or list.^a - Text block in MDT forms. - Work-up-day to gather all information in one day Determine a standard presentation format including the mentioning of patient-centered information. All involved specialties prepare relevant cases.	Patient-centered information. Knowing goals and preferences. Individualized information.
	Information following MDT	Standardize the written report, including options, pros and cons, arguments, or uncertainties.^a Chair supervises thorough reporting. Designate a co-chair for thorough reporting. Clinic appointment with most relevant specialties following MDT meeting (“carrousel meeting”). Physician in charge discusses MDT report with patient, eg, options, pros and cons, uncertainty. Disclose MDT written report to the patient.	More information following MDT meeting. To discuss information with the patient.

Note: ^aitems (partially) derived from the list of strategies.

Abbreviations: MDT, multidisciplinary cancer team. GP, general practitioner.

Figure 1 Cancer-related decision-making process. At suspicion of malignancy the physician discusses the possible diagnosis and treatment options with the patient (team talk and, if possible, option talk). Patient-centered information is acquired (preference talk) and additional diagnostics are ordered. The treating physician discusses the patient case in the MDT meeting, where an advice is formulated and well-documented. The team aims to align MDT decision-making with Shared Decision-Making with the patient. Then, the physician translates the MDT advice to the patient and integrates this with the patient towards a personalized treatment plan. Options are explained with pros and cons (option talk) and preferences are discussed (preference talk). The treatment is applied. During decision-making or treatment, the MDT may be consulted again, when necessary.

Abbreviation: SDM, Shared Decision-Making.