Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments
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Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members’ contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.
Materials and Methods
Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients’ views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere–Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman’s correlations.
Quality of information presentation: Case histories and radiology information rated highest; patients’ views and comorbidities/psychosocial issues rated lowest (observed: Z = 14.80, P ≤ 0.001; self-report: Z = 3.70, P < 0.001). Contribution to decision-making: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed: Z = 20.00, P ≤ 0.001; self-report: Z = 8.10, P < 0.001). Correlations between observational and self-report assessments: Median Spearman’s rho = 0.74 (range = 0.66–0.91; P < 0.05).
The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.
KeywordsTeam Performance Observational Assessment Team Behavior Observational Tool Terpstra Test
We are grateful to the Pelican Cancer Foundation (UK) and Action for Bladder Cancer (UK) for facilitating the research reported here. This work was supported by the National Institute for Health Research through the Imperial Centre for Patient Safety and Service Quality and Whipps Cross University Hospital NHS Trust R&D Department. The funding source played no role in study design, collection, analysis or interpretation of data, in the writing of the report or the decision to submit the paper for publication. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.
Conflict of interest
The authors report no conflicts of interest.
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