title: [Value of a multidisciplinary team for patients with a urological malignancy].
abstract: OBJECTIVE
  To evaluate degree of agreement between treatment proposals from urologist and a multidisciplinary team (MDT) for patients with an urological malignancy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All letters from patients with an urological malignancy of prostate, bladder, kidney or testicle who were discussed at the MDT in Ziekenhuisgroep Twente from January 2011 until January 2013 were collected. This study studied the level and frequency of agreement between treatment proposals from urologist and MDT. Level of agreement was expressed by using Cohen's Kappa. Also treatments proposed by the MDT were compared to the final treatment choice of the patient.
  
  
  RESULTS
  A total of 788 letters were analysed. For 9%, the MDT disagreed with the treatment recommended by the urologist. This disagreement was most often observed in patients with malignancy of kidney (κ: 0.507; p < 0.001). Agreement for patients with malignancy of bladder, testicle and prostate were substantial (respectively κ: 0.719; p < 0.001, κ: 0.803; p < 0.001, κ: 0.634; p < 0.001). Treatment proposals "brachytherapy" and "external radiotherapy" for prostate malignancy showed only moderate agreement (κ: 0.564 and κ: 0.568; p < 0.001 respectively). 93% of all patients elected to take (one of) the treatment proposals made by the MDT.
  
  
  CONCLUSIONS
  A multidisciplinary approach seems particularly useful for patients with malignancy of kidney. The additative value of MDT was less visible for patients with malignancy of prostate, which could be due to less consistent guidelines. Final treatment decision might be influenced by explanation and guidance of the treating urologist.
authors.affiliation: Ziekenhuisgroep Twente, afd. Urologie, Hengelo.
authors.forename: Lucy  K
authors.initials: L
authors.lastname: Pelikaan
authors.forename: Jessica L J
authors.initials: JL
authors.lastname: Vriesema
authors.forename: Marjolein G J
authors.initials: MG
authors.lastname: Brusse-Keizer
authors.forename: Erik B
authors.initials: EB
authors.lastname: Cornel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000628:therapy*; D014573:Urology Department, Hospital