title: Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: an interview study of the provider perspective.
abstract: BACKGROUND
  It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs.
  
  
  METHODS
  Semi-structured interviews were carried out with expert MDT members of Urological and Gastro-Intestinal tumours of 3 London (UK) hospitals. The standardised interview protocol assessed MDT experts' views on decision-making, barriers to reaching a decision and implementing it into care, and interventions to improve this process. All interviews were audio-taped, transcribed verbatim and analysed using a standardised approach. Emergent themes were identified by 2 clinical coders and tabulated.
  
  
  RESULTS
  Twenty-two participants participated in the study and data collection achieved 'saturation' (i.e., similar themes raised by different participants). Barriers to clinical decision-making included: inadequate clinical information; lack of investigation results; non-attendance of key members; teleconferencing failures. Barriers to implementation of MDT recommendations included: non-consideration of patients' choices or co-morbidities; disease progression at the time of implementation. Proposed interventions included improving the information available for the discussion through a standardised proforma; improving video-conferencing; reducing the MDT caseload (e.g., via selective MDT review of certain patients); and including patients more in the decision process.
  
  
  CONCLUSIONS
  There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, 5th Floor Medical School Building, St. Mary's Hospital, London W2 1PG, UK. r.jalil@imperial.ac.uk
authors.forename: Rozh
authors.initials: R
authors.lastname: Jalil
authors.forename: Maria
authors.initials: M
authors.lastname: Ahmed
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D003657:Decision Making; D003661:Decision Support Techniques; D006126:Group Processes; D006801:Humans; D007407:Interviews as Topic; D008495:Medical Oncology / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D010348:Patient Care Team