title: TELEMAM: a cluster randomised trial to assess the use of telemedicine in multi-disciplinary breast cancer decision making.
abstract: OBJECTIVE
  The TELEMAM trial aimed to assess the clinical effectiveness and costs of telemedicine in conducting breast cancer multi-disciplinary meetings (MDTs).
  
  
  METHODS
  Over 12 months 473 MDT patient discussions in two district general hospitals (DGHs) were cluster randomised (2:1) to the intervention of telemedicine linkage to breast specialists in a cancer centre or to the control group of 'in-person' meetings. Primary endpoints were clinical effectiveness and costs. Economic analysis was based on a cost-minimisation approach.
  
  
  RESULTS
  Levels of agreement of MDT members on a scale from 1 to 5 were high and similar in both the telemedicine and standard meetings for decision sharing (4.04 versus 4.17), consensus (4.06 versus 4.20) and confidence in the decision (4.16 versus 4.07). The threshold at which the telemedicine meetings became cheaper than standard MDTs was approximately 40 meetings per year.
  
  
  CONCLUSIONS
  Telemedicine delivered breast cancer multi-disciplinary meetings have similar clinical effectiveness to standard 'in-person' meetings.
authors.affiliation: Department of Clinical Oncology, Western General Hospital, Edinburgh EH4 2XU, United Kingdom. I.Kunkler@ed.ac.uk
authors.forename: I H
authors.initials: IH
authors.lastname: Kunkler
authors.forename: R J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: R J
authors.initials: RJ
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Brebner
authors.forename: J A
authors.initials: JA
authors.lastname: Cairns
authors.forename: R G
authors.initials: RG
authors.lastname: Fielding
authors.forename: A
authors.initials: A
authors.lastname: Bowman
authors.forename: G
authors.initials: G
authors.lastname: Neades
authors.forename: A D F
authors.initials: AD
authors.lastname: Walls
authors.forename: U
authors.initials: U
authors.lastname: Chetty
authors.forename: J M
authors.initials: JM
authors.lastname: Dixon
authors.forename: M E
authors.initials: ME
authors.lastname: Smith
authors.forename: T W
authors.initials: TW
authors.lastname: Gardner
authors.forename: M
authors.initials: M
authors.lastname: Macnab
authors.forename: S
authors.initials: S
authors.lastname: Swann
authors.forename: J R
authors.initials: JR
authors.lastname: Maclean
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D003657:Decision Making; D005260:Female; D006767:Hospitals, District; D006801:Humans; D010348:Patient Care Team; D012423:Rural Health; D012606:Scotland; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome