title: Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study.
abstract: BACKGROUND
  The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members' views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting.
  
  
  METHODS
  Members of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings.
  
  
  RESULTS
  173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work.
  
  
  CONCLUSIONS
  Key urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical practice.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, 5th Floor Medical School Building, St, Mary's Hospital, London W2 1PG, UK. Benjamin.lamb@imperial.ac.uk.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Lamb
authors.forename: Rozh T
authors.initials: RT
authors.lastname: Jalil
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
mesh_terms: D003430:Cross-Sectional Studies; D006126:Group Processes; D019538:Health Care Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D058996:Quality Improvement; D014571:Urologic Neoplasms / Q000628:therapy*