title: Uro-oncology multidisciplinary meetings at an Australian tertiary referral centre--impact on clinical decision-making and implications for patient inclusion.
abstract: OBJECTIVE
  To analyse the impact of the uro-oncology multidisciplinary meeting (MDM) at an Australian tertiary centre on patient management decisions, and to develop criteria for patient inclusion in MDMs.
  
  
  METHODS
  Over a 3-month period, all cases presented at our weekly uro-oncology MDM were prospectively assessed, by asking the presenting clinician to state their provisional management plans and comparing this with the subsequent consensus decision. The impact of the MDM was graded as high if there was a major change in the management plan or if a plan was developed where there was none.
  
  
  RESULTS
  Over the study period, 120 discussions about 107 patients were recorded. Prostate, urothelial, kidney and testis cancer represented 46 (38.3%), 36 (30%), 26 (21.6%) and 12 (10%) of the discussions, respectively. The MDM made high impact changes to the original plan in 32 (26.7%) cases. High impact changes were nearly twice as likely to occur in patients with metastatic disease as in those without metastases (P < 0.05). Primary cross referral between disciplines occurred in 40 (33.3%) cases, including 66.7% of testicular and 42% of bladder cancers but only 26% of prostate and 19% of kidney cancers (P < 0.02).
  
  
  CONCLUSIONS
  The uro-oncology MDM alters management plans in about one-quarter of cases. Additionally, MDMs also serve other purposes, such as cross-referral or consideration for clinical trials. Patients should be discussed in MDMs if multimodal therapy may be required, clinical trial eligibility is being considered or if metastasis or recurrence is noted.
authors: Department of Urology, Austin Health, Melbourne, VIC, Australia.
authors: Kenny
authors: K
authors: Rao
authors: Kiran
authors: K
authors: Manya
authors: Arun
authors: A
authors: Azad
authors: Nathan
authors: N
authors: Lawrentschuk
authors: Damien
authors: D
authors: Bolton
authors: Ian D
authors: ID
authors: Davis
authors: Shomik
authors: S
authors: Sengupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D032921:Consensus; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration*; D014565:Urogenital Neoplasms / Q000628:therapy*; D055815:Young Adult
keywords: decision making; multidisciplinary meeting (MDM); multidisciplinary team (MDT); uro-oncology