title: Analysis of time taken to discuss new patients with head and neck cancer in multidisciplinary team meetings.
abstract: Multidisciplinary team (MDT) meetings have an important role in the management of head and neck cancer. Increasing incidence of the disease and a drive towards centralised meetings on large numbers of patients mean that effective discussions are pertinent. We aimed to evaluate new cases within a single high volume head and neck cancer MDT and to explore the relation between the time taken to discuss each case, the number of discussants, and type of case. A total of 105 patients with a new diagnosis of head and neck malignancy or complex benign tumour were discussed at 10 head and neck cancer MDT meetings. A single observer timed each discussion using a stopwatch, and recorded the number of discussants and the diagnosis and characteristics of each patient. Timings ranged from 15 to 480 s (8 min) with a mean of 119 s (2 min), and the duration of discussion correlated closely with the number of discussants (rs=0.63, p<0.001). The longest discussions concerned patients with advanced T stage (p=0.006) and advanced N stage (p=0.009) disease, the elderly (p=0.02) and male patients (p=0.05). Tumour site and histological findings were not significant factors in the duration of discussion. Most discussions on patients with early stage tumours were short (T1: 58% less than 60s, mean 90) and fewer people contributed. Many patients, particularly those with early stage disease, require little discussion, and their treatment might reasonably be planned according to an agreed protocol, which would leave more time and resources for those that require greater multidisciplinary input. Further studies may highlight extended discussions on patients with head and neck cancer, which may prompt a review of protocols and current evidence.
authors.affiliation: Oral and Maxillofacial Surgery Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom; University of Liverpool, United Kingdom. Electronic address: Barrymullan@doctors.org.uk.
authors.forename: B J
authors.initials: BJ
authors.lastname: Mullan
authors.affiliation: Oral and Maxillofacial Surgery Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom.
authors.forename: J S
authors.initials: JS
authors.lastname: Brown
authors.affiliation: Oral and Maxillofacial Surgery Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom; Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.affiliation: Oral and Maxillofacial Surgery Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom; Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, United Kingdom.
authors.forename: S N
authors.initials: SN
authors.lastname: Rogers
authors.affiliation: Oral and Maxillofacial Surgery Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L9 7AL, United Kingdom; Head & Neck Surgery, Department of Molecular & Clinical Cancer Medicine, University of Liverpool, United Kingdom.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shaw
mesh_terms: D000367:Age Factors; D000368:Aged; D002985:Clinical Protocols; D003142:Communication; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D007822:Laryngeal Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000628:therapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000628:therapy; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors
keywords: Discussion length; Head and neck cancer; MDT; Multidisciplinary team