title: Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients.
abstract: BACKGROUND
  Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions.
  
  
  METHODS
  We conducted a prospective longitudinal study during 16 months that evaluated MTB decision making for urological cancer patients at a university hospital in London, UK. After a baseline period, MTB improvement interventions (eg, MTBs checklist, MTB team training, and written guidance) were delivered sequentially. Outcomes measures were the MTB's ability to reach a decision, the quality of information presentation, and the quality of teamwork (as assessed by trained assessors using a previously validated observational assessment tool). The efficacy of the intervention was evaluated using multivariate analyses.
  
  
  RESULTS
  There were 1,421 patients studied between December 2009 and April 2, 2011. All outcomes improved considerably between baseline and intervention implementation: the MTB's ability to reach a decision rose from 82.2% to 92.7%, quality of information presentation rose from 29.6% to 38.3%, and quality of teamwork rose from 37.8% to 43.0%. The MTB's ability to reach a treatment decision was related to the quality of available information (r = 0.298; p < 0.05) and quality of teamwork within the MTB (r = 0.348; p < 0.05). The most common barriers to reaching clinical decisions were inadequate radiologic information (n = 77), inadequate pathologic information (n = 51), and inappropriate patient referrals (n = 21).
  
  
  CONCLUSIONS
  Multidisciplinary tumor board-delivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK. benjamin.lamb@imperial.ac.uk
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Lamb
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benn
authors.forename: Katrina F
authors.initials: KF
authors.lastname: Brown
authors.forename: Charles A
authors.initials: CA
authors.lastname: Vincent
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D000704:Analysis of Variance; D057189:Checklist; D006801:Humans; D007318:Inservice Training; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008137:Longitudinal Studies; D010348:Patient Care Team; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D014571:Urologic Neoplasms / Q000628:therapy*
keywords: MODe; MTB; Metric of Decision Making; QuIC; WXUH; Whipps Cross University Hospital; multidisciplinary tumor board; quality-improvement checklist