Evaluation of multidisciplinary cancer management in a regional South Australian centre: are multidisciplinary team recommendations being implemented?

Aims: To determine whether recommended referrals and treatment decisions of a generic cancer multidisciplinary team (MDT) have been implemented and to compare the patterns of cancer management between MDT recommendations and therapeutic care delivered. Methods: A retrospective review of medical records was conducted between May and July 2009 in a regional public hospital in South Australia. Medical records of all cancer patients whose cases had been reviewed by the MDT between October 2008 and May 2009 were eligible to be audited. A 29-item medical record audit checklist was designed to collect evidence of the recording and implementation of outcomes and recommendations resulting from regular MDT meetings. The audit also collected data to determine whether MDT recommendations had been discussed with patients. Results: The sample included records for 53 patients (57% male), with a mean age of 68.1 years (SD 13.5, range 15–93 years) and 50% residing in areas defined as ‘outer regional’ by the Australian Standard Geographical Classification Remoteness Areas classification. Overall, 11 different tumour types had been discussed by the MDT during the period considered, with diagnosis including colon cancer (43%), rectal cancer (19%) and upper gastro-intestinal cancer (11%). The majority of cases (62%) were discussed only once by the MDT, with remaining cases being reviewed up to three times. MDT outcomes and recommendations were recorded in all 53 (100%) case notes. The inpatient and outpatient sections of 47 (89%) case notes demonstrated evidence of implementation of MDT recommendations, with clear evidence that MDT meeting outcomes had been discussed with 43 (81%) patients. There were no statistically significant discordance between proposed MDT referrals and treatment recommendations and the therapeutic care delivered. Conclusion: This study demonstrates that MDT recommendations for cancer management are being implemented and thereby suggests that the MDT was effective in disseminating its treatment recommendations