title: Not all patients need to be discussed in a colorectal cancer MDT meeting.
abstract: OBJECTIVE
  It is recommended that patients with cancer should be managed in the context of a multidisciplinary team (MDT). Alternatively, proponents of the standard model of care propose that the well-informed treating doctor is able to make the appropriate plan for each patient, making the need for a MDT meeting redundant. We compared the management plans made within a colorectal cancer MDT with routine care.
  
  
  METHODS
  Consecutive cases presenting to the colorectal MDT were prospectively assessed. Before the meeting management plans were made, based on routine care pathways. These were compared with plans made at the MDT meeting and discrepancies recorded. The number of patients who generated beneficial discussion was recorded.
  
  
  RESULTS
  There were 261 discussions regarding the care of 197 patients. In the 203 cases where the pathways were relevant, patient management was consistent with the pathway in 94% of the cases discussed. Discussion of routine cases of colon cancer rarely changed management (3.4%). Conversely, management changed after MDT discussion in 50% of complex cases (the preoperative management of rectal cancer, recurrence, metastatic disease and malignant polyps). The postoperative discussion of pathology findings rarely generated beneficial discussion.
  
  
  CONCLUSIONS
  Discussion of routine cases of colon cancer in our MDT rarely changed management, but it did change the decisions regarding complex cases or in patients with unusual pathology. We propose a two-tiered approach to the MDT where all patients are listed for a MDT meeting but only patients with complex pathology are discussed in detail.
authors.affiliation: Department of Surgery, Colorectal Unit, Western Health, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Ryan
authors.forename: I
authors.initials: I
authors.lastname: Faragher
mesh_terms: D001291:Attitude of Health Personnel; D003110:Colonic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003226:Congresses as Topic / Q000706:statistics & numerical data*; D019091:Critical Pathways; D003657:Decision Making; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012017:Referral and Consultation; D059039:Standard of Care
keywords: Colorectal cancer; decision making; interdisciplinary communication; multidisciplinary team; patient care team/*organization & administration