Measuring the quality of MDT working: an observational approach.
BACKGROUND
Cancer multidisciplinary teams (MDTs) are established in many countries but little is known about how well they function. A core activity is regular MDT meetings (MDMs) where treatment recommendations are agreed. A mixed methods descriptive study was conducted to develop and test quality criteria for observational assessment of MDM performance calibrated against consensus from over 2000 MDT members about the "characteristics of an effective MDT".


METHODS
Eighteen of the 86 'Characteristics of Effective MDTs' were considered relevant and feasible to observe. They collated to 15 aspects of MDT working covering four domains: the team (e.g. attendance, chairing, teamworking); infrastructure for meetings (venue, equipment); meeting organisation and logistics; and patient-centred clinical decision-making (patient-centredness, clarity of recommendations). Criteria for rating each characteristic from 'very poor' to 'very good' were derived from literature review, observing MDMs and expert input. Criteria were applied to 10 bowel cancer MDTs to assess acceptability and measure variation between and within teams. Feasibility and inter-rater reliability was assessed by comparing three observers.


RESULTS
Observational assessment was acceptable to teams and feasible to implement. Total scores from 29 to 50 (out of 58) highlighted wide diversity in quality between teams. Eight teams were rated either 'very good/good' or 'very poor/poor' for at least three domains demonstrating some internal consistency. 'Very good' ratings were most likely for attendance and administrative preparation, and least likely for patient-centredness of decision-making and prioritisation of complex cases. All except two characteristics had intra-class correlations of ≥0.50.


CONCLUSIONS
This observational tool (MDT-OARS) may contribute to the assessment of MDT performance. Further testing to confirm validity and reliability is required.
Florence Nightingale School of Nursing & Midwifery, King's College London, England. cath.taylor@kcl.ac.uk
Cath
C
Taylor
Louise
L
Atkins
Alison
A
Richardson
Ruth
R
Tarrant
Amanda-Jane
AJ
Ramirez
D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D009369:Neoplasms / Q000628:therapy; D010348:Patient Care Team / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care