Waiting times for cancer treatment: the impact of multi-disciplinary team meetings

Abstract

In the UK, treatment recommendations for patients with cancer are all made within multi-disciplinary team (MDT) meetings. This has benefits, but it may delay treatment starting if MDT decisions require revision before implementation. This study examined whether changes in MDT treatment decisions after the meeting led to a delay in the start of treatment. Consecutive MDT treatment recommendations were recorded and times to start of treatment were calculated. Comparisons of the time from MDT meeting to start of treatment were made between implemented and non-implemented MDT recommendations. Of 363 MDT recommendations, 71 (19.5%, 95% CIs 15.6–24.0) were not implemented. The median time to start of treatment was 24 days (IQR 12–33), increasing to 35 days (IQR 17–77.5), if the MDT decision required revision to another active therapy (p = 0.009). Decisions were changed because details about co-morbidity (n = 32, 45%), new clinical information (n = 24, 34%) or patient choice became apparent (n = 13, 18%) and two changed for no clear reason. Significant delays in starting treatment occur if team treatment recommendations are not implemented. Effort and resources are required to ensure that information is present at meetings to allow comprehensive patient-centred decisions to be made and implemented.

Keywords:

• multi-disciplinary team meetings
• decision making
• patient-centred care
• health service organisation

Acknowledgements

The authors thank the clinical nurse specialists Joanna Witherstone, Laura Pope, Sue Osborne, Jo Price, Karen Low, Rachel Warman and Issy Battiwalla and MDT coordinators Paula Burge from Weston and Julie Edwards from Yeovil for their help retrieving this data. This research was supported, in part, by University Hospitals Bristol NHS Foundation Trust Enabling Fund.