title: Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended?
abstract: BACKGROUND
  A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit.
  
  
  METHODS
  All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant.
  
  
  RESULTS
  Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered 'unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered 'justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5).
  
  
  CONCLUSIONS
  The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were 'unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.
authors.affiliation: Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK. sabrinarajan@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Rajan
authors.forename: J
authors.initials: J
authors.lastname: Foreman
authors.forename: M G
authors.initials: MG
authors.lastname: Wallis
authors.forename: C
authors.initials: C
authors.lastname: Caldas
authors.forename: P
authors.initials: P
authors.lastname: Britton
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D002277:Carcinoma / Q000453:epidemiology / Q000628:therapy*; D002755:Choice Behavior; D003657:Decision Making / Q000502:physiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D019300:Medical Errors / Q000706:statistics & numerical data; D033283:Patient Access to Records / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies