Multidisciplinary team meetings in cancer care may be stretched to the limit – facing challenges such as increasing patient numbers, time constraints and under-resourcing.
A recent review article by a NSW team, juxtaposing real world limitations against best practice guidelines, highlights some of the pressure points.
For example, time pressures can limit the contributions each MDT member can make to a meeting.
“In overburdened MDT meetings, communication is truncated and equal contribution to case discussion by all team members is unlikely. Additionally, the motivation to make a contribution may be weakened,” they said.
“Early MDT meetings were established by enthusiastic individuals. As meetings become bureaucratically mandated, there is a risk that some members are merely attending, without full engagement in the process.”
The authors said nurses, who might best represent patient preferences, and allied health professionals may find it particularly difficult to participate in a busy MDT meeting.
They added the supportive care needs of the patient were more likely to be managed outside the MDT meeting.
The review concluded that better resourcing of the MDT meeting would be helpful to optimise patient outcomes and help meet other goals such as maintaining standards of best practice and professional development.
In an accompanying editorial, a Queensland team also highlighted the potential limitations on truly multidisciplinary decision-making.
“Typically, and understandably, especially when there is meeting time pressure, decision making favours the highly technical clinical information and expertise over the more experiential psychological and social factors – potentially resulting in reduced clinician engagement in the MDT and less than an optimal treatment plan.”
They said “skillful relating” – the ability to keep the many different voices involved and the conversations balanced – was critical to more inclusive decision-making.
Co-author Dr Monika Janda, a Professor in Behavioural Science at the University of Queensland, told the limbic supportive care may not get as much say as other components of care if the meeting chair was not skilled enough to draw them into the conversation.
“It’s very important that the person who is the lead of the multidisciplinary team allows everyone to have a voice. Because often there are so many patients to discuss, it can be a challenge to really make sure if the psychologists have been heard or if there is a physiotherapy component that would be important.”
She said the Queensland government has been supporting MDT meetings with, for example, administrative assistance to set agendas, get everyone together, take minutes, and action items.
The Queensland Oncology On Line (QOOL) system was also connecting outcomes data on a number of cancers to help MDT meetings identify optimal practice and its relevance to individual patients and their circumstances.
She said another practical support was providing reimbursement to ensure in-demand MDT members with highly specialised skills were available to attend certain meetings.