oa Barriers to decision making in cancer multidisciplinary teams: Analysis of cancer decision-making in two surgical specialities

Introduction: Multidisciplinary teams (MDTs) in cancer care have been instituted for almost 20 years. The rationale for MDT-driven care is that bringing together cancer specialists from a range of disciplines allows holistic and unbiased review of treatment options and optimisation of treatment pathways for patients. Multidisciplinary teams are becoming the standard practice in managing cancer patients in the world. The Multidisciplinary team (MDT) is defined as a "group of people of different healthcare disciplines, which meets together at a given time (whether physically in one place, or by video or teleconferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient". These teams meet regularly, review investigation results and discuss best available, evidence based treatment options for cancer patients. In the UK, there is a quality assurance program for the function and structure of the MDTs; however there no agreed way to assess the process and the ability of decision making of such teams. This study investigated the factors hampering decision-making in cancer MDT meetings. Methods: All available MDT decision outcomes of cancer patients discussed between February to December 2012 of both Urology and Colorectal surgery were reviewed. MDT decisions and reasons for cases with no decision reached were analysed. Results: MDT discussion outcome of 2035 cancer cases were reviewed (19 Urology MDT meetings, n=1126, 50 Colorectal MDT meetings, n=909). 9.5 %( n=107) of Urology and 6.4 %( n=58) of colorectal cases had no decision reached. Main reasons were: unavailability of histopathological results (47.7%(n=51) of urology and 24.1%(n=14) of Colorectal cases); unavailability of radiological investigation results (43.9%(n=47) of Urology and 43.1%(n=25) of Colorectal cases); unavailability of an Oncologist in the meeting(3.7%(n=4) of Urology and 5.2%(n=3) of Colorectal cases). Discussion: This study uncovers the main barriers that MDTs face in decision-making. Assessing the efficacy of a MDT could be made by its capability to formulate a decision plan for all the cases discussed. Tackling these barriers would result in a more cost-effective process, enhance decision-making and thus enhance cancer care.