Improving MDTMs in Surrey and Sussex
Research type
Research Study
Full title
Improving the effectiveness of cancer multidisciplinary team meetings (MDTMs) in Surrey and Sussex
IRAS ID
270697
Contact name
Cat Taylor
Contact email
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Research Summary
This project aims to improve the effectiveness and efficiency of cancer multidisciplinary team meetings (MDTMs) in routine NHS practice in Surrey and Sussex. Cancer MDTMs are a weekly forum where individual patients are discussed and treatment recommendations agreed by a range of professionals required for that specific tumour type. The current cancer strategy for England recommends reform to prioritise complex cases (patients) for discussion but lacks guidance on how to do it. In addition there is evidence of lack of efficiency in these meetings for example due to missing information. These sorts of inefficiencies can cause delays to treatment (and at worst lead to poorer prognosis) and are a source of job stress for staff, triggering frustration and disengagement in meetings.
Therefore this project will implement and evaluate an intervention package comprising 3 tools within 11 MDTMs across three tumour types. Two tools are already developed: MDT-FIT to help teams evaluate and plan improvements to their teamworking, and MDT-QuIC to support teams to ensure adequacy of patient information in MDTMs). A third component will involve the development of a streamlining protocol (to prioritise complex patient cases for full MDTM discussion, and to determine how recommendations for other patients should be made) using a method called modified Delphi consensus. A range of outcome measures will be collected and compared pre and post intervention implementation, with the primary measure being the change in percentage of decisions changed following MDTMs as a result of information not being available to the MDT (as we know that approximately 15% of MDT recommendations are changed after the meeting).
The participants will be cancer health professionals (MDT members and associated staff e.g. cancer management), though pseudo-anonymised patient data will be used to evaluate the impact of the interventions.Summary of Results
This project aimed to improve the effectiveness and efficiency of lung cancer multidisciplinary team meetings (MDTMs) in routine NHS practice in Surrey and Sussex. Cancer MDTMs are a weekly forum where individual patients are discussed, and treatment recommendations agreed by a range of professionals required for that specific tumour type.
Study findings are based on (a) observation of 12 consecutive MDTMs in 8 multidisciplinary teams, comprising a total of 1671 case discussions; (b) follow up data regarding implementation of MDM recommendations in the cohort of 737 patients; (c) a total of 57 interviews conducted with 41 MDT members/CSMs (15 participants interviewed at two timepoints).
Significant variability was found in ways of working across the 8 participating MDTs, however all of the MDTs discussed a high proportion of diagnostic cases, deferred making diagnostic and treatment decisions and discussed cases multiple times at pre- and post- diagnostic stages. It was found that the likelihood of a treatment recommendation being made at the MDTM was 190% higher if fitness information was available to MDT members. Inefficiencies in diagnostic pathways, low availability of patient information and MDT member absence at MDMs were identified as some of the issues affecting MDTM efficiency.
The impact of moving to virtual MDTMs was also evaluated. Despite some benefits of virtual MDTMs being identified, such as improved access and imaging quality, it was found that IT obstacles have the potential to impact heavily on valuable MDTM time. Improvements in the IT infrastructure of NHS Trusts is required to conduct effective and efficient MDTMs.
This project also developed, through co-design with Lung MDT members a streamlining protocol to improve efficiency and effectiveness in Lung MDT meetings. Barriers to its implementation related to the MDTs’ outer setting (MDTs relying on other hospitals for services), inner setting (staffing, internal communication and referral processes), characteristics of individual team members (familiarity with protocol) and the intervention itself (need for whole system change and re-education of staff). However, it was found that use of co-design methods ensured engagement and ownership of change by frontline staff, and a resulting protocol that could have significant benefit.
REC name
London - Fulham Research Ethics Committee
REC reference
19/LO/1699
Date of REC Opinion
13 Feb 2020
REC opinion
Further Information Favourable Opinion