Developing a decision-making model based on an interdisciplinary oncological care group for the management of colorectal cancer.
OBJECTIVE
To report our experience on implementation and preliminary results of a decision-making model based on the recommendations of an Interdisciplinary Oncological Care Group developed for the management of colorectal cancer.


METHODS
The multidisciplinary team identified a reference guideline using appraisal of guidelines for research and evaluation (AGREE) tool based on a sequential assessment of the guideline quality. Thereafter, internal guidelines with diagnostic and therapeutic management for early, locally advanced and metastatic colonic and rectal cancer were drafted; organizational aspects, responsibility matrices, protocol actions for each area of specialty involved and indicators for performing audits were also defined.


RESULTS
The National Institute for Health and Care Excellence (NICE) UK guideline was the reference for drafting the internal guideline document; from February to November 2013, 125 patients with colorectal cancer were discussed by and taken under the care of the Interdisciplinary Oncological Care Group. The first audit performed in December 2013 revealed optimal adherence to the internal guideline, mainly in terms of uniformity and accuracy of perioperative staging, coordination and timing of multi-modal therapies. To date, all patients under observation are within the diagnostic and therapeutic course, no patient came out from the multidisciplinary "path" and only in 14% of cases have the first recommendations proposed been changed. The selected indicators appear effective and reliable, while at the moment, it is not yet possible to assess the impact of the multidisciplinary team on clinical outcome.


CONCLUSIONS
Although having a short observation period, our model seems capable of determining optimal uniformity of diagnostic and therapeutic management, to a high degree of patient satisfaction. A longer observation period is necessary in order to confirm these observations and for assessing the impact on clinical outcome.
Department of Radiotherapy SS. Annunziata Hospital, via dei Vestini, 66100 Chieti, Italy. d.genovesi@unich.it.
Domenico
D
Genovesi
Lorenzo
L
Mazzilli
Marianna
M
Trignani
Monica
M
DI Tommaso
Antonio
A
Nuzzo
Edoardo
E
Biondi
Nicola
N
Tinari
Maria Teresa
MT
Martino
Paolo
P
Innocenti
Pierluigi
P
DI Sebastiano
Lorenzo
L
Mazzola
Carmine
C
Lanci
Matteo
M
Neri
Francesco
F
Laterza
Maria
M
Marino
Giovanni
G
Ferrini
Antonio
A
Spadaccini
Antonella
A
Filippone
Enzo
E
DI Giandomenico
Antonio
A
Marulli
Giuseppe
G
Palombo
Antonio
A
Sparvieri
Antonio
A
Marchetti
Giuseppe
G
Pizzicannella
Flavia
F
Petrini
Maria
M
DI Felice
Floriana
F
Ottaviani
Antonio
A
Monteodorisio
Marta
M
DI Nicola
Giampiero Ausili
GA
Cefaro
D015179:Colorectal Neoplasms / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*
Colorectal cancer; decision-making; multidisciplinary teams