How effective is a virtual consultation process in facilitating multidisciplinary decision-making for malignant epidural spinal cord compression?
OBJECTIVE
The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC).


METHODS
A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation.


RESULTS
After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%.


CONCLUSIONS
The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes.
Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto, Canada.
David
D
Fitzpatrick
Daniel
D
Grabarz
Lisa
L
Wang
Andrea
A
Bezjak
Michael G
MG
Fehlings
Christopher
C
Fosker
Raja
R
Rampersaud
Rebecca K S
RK
Wong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D032921:Consensus; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D018787:Radiation Oncology / Q000379:methods; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D017216:Telemedicine / Q000379:methods*