Communication in neuro-oncology multidisciplinary team meetings (MDTM's)

Background The aim of MDTM’s is to ensure that all patients receive qualitative care from appropriately skilled professionals. However, empirical research shows that multidisciplinary team discussions do not always live up to their positive expectations. In discussions the team cycles through three main communicative phases: exploration, discussion and conclusion. The goal of this study is to gain insight in the structure of regional neuro-oncology MDTM’s and find an overarching reason why some discussions follow a different structure (or phase shifts) than others. Material and Methods We recorded 14 neuro-oncology MDTM’s in an non-academic Dutch Hospital by audio and video. All recordings were transcribed into time stamped sequences of verbal contributions. Every time stamped sequence was coded using a developed coding scheme. Results In total 14 regional Neuro-oncology MDMT’s were recorded, this resulted in 437 patient case reviews and 12512 coded verbal contributions. In each meeting the uniquely contributing members ranged from 12-21 members (M= 15.5, SD = 2.71) from 5 different institutions. The average of different disciplines was 7 disciplines (M=7.14, SD = 0.77). In 41% of the patient discussions there are two or three contributing disciplines in the decision making process. The maximum number of uniquely participating members in a patient discussion is 8 members. In only 28% of the case discussions 5 or more participants participated. Different categories for discussing a patient in an MTDM were found, these categories varied in specificity. From high to low specificity we found: justifying actions, pathology reviews, action-directed questions and open questions. We also found that in 20% of all patient case discussions the teams bypass the discussion phase. Conclusion MDTM’s are widely accepted and implemented. Therefore we should gain more insight in the structure and functioning of such teams. We found that there are different reasons for presenting a case which vary in their specificity. Our findings show that teams seem to deviate from the overall communication structure by bypassing the discussion phase in 20% of the cases. We also found that in 28% of patient discussions more than five participants contributed to the discussion. A future direction of organisation of MDTMs could be to clearly categorize on beforehand the patient questions in order to make the MDTM more efficient. Further analysis will include quality evaluation of MDTM’s, in neuro-oncology and other oncology domains. Support/Disclosure: this research is funded by WeCare (an collaboration between Tilburg University and Elisabeth-Tweesteden hospital)