An examination of the dynamics and processes of cancer multidisciplinary meetings (MDMs)

© 2016 Dr. Bianca Alix DevittMultidisciplinary cancer meetings (MDMs) are treatment planning meetings where a group of health professionals regularly meet to review patients’ histories, pathology and radiology results and formulate a management plan. They were developed and implemented in an attempt to standardise and improve cancer outcomes and have become a fundamental component of quality cancer care. National and international guidelines on MDM conduct exist. Such guidelines are based on expert opinion, since there is a paucity of evidence available in the area. There remain a number of areas of MDM conduct where little is known, including: patients’ views on this model of care and their preferences for interaction with the MDMs, the role of supportive care within MDMs, and how disagreements around recommended treatment plans should and are being managed. The research presented in this thesis used a mixed methods approach to explore and understand the conduct and dynamics of cancer MDMs in order to develop evidence based guidelines for their conduct. These guidelines were refined through a Delphi consensus process involving Australian leaders in cancer care. Finally, after identifying potential deficiencies in the functioning of MDMs, a pilot study was performed to test a new model of care whereby the provision of comorbid and psychosocial details was standardised during MDM treatment planning. Health professionals and patients were strongly supportive of MDMs. They believed discussion at MDMs improved patient outcomes, increased likelihood that patients would receive evidence-based care and were an efficient means of treatment planning. Secondary benefits of MDMs include improved interdisciplinary communication and teamwork, education and peer support. Both health professionals and patients reported the primary goal of MDM was to develop a single consensual recommendation of an individualised, evidence based treatment plan. There were substantive differences in the reported role of supportive care planning within this context. Most health professionals and patients believed sufficient information around co-morbid and psychosocial details should be provided to the MDM in order to individualise treatment decisions but did not think it the appropriate forum to develop a comprehensive supportive care plan. Many MDMs do not function to consider these co-morbid and psychosocial details in a systematic way and models of care that incorporate this information are strongly supported by clinicians. The MDM process reassured patients. Most acknowledged the expertise of the MDM team and favoured a single, consensus treatment plan even when treatments under consideration were equivocal in their outcomes. Similarly, health professionals most valued MDM discussion for cases where decision making was complex. There were significant deficiencies in the documentation of MDM discussion and no processes for quality assurance. The guidelines developed and refined through the Delphi process provided a framework to measure performance and ensure the aims of MDMs are met. Patients and health professionals endorsed MDMs as an efficient and effective means of cancer treatment planning. MDMs will need to adapt in the near future to contend with the increasing burden of cancer in our aging community often in a medically and socially complex group of patients