Multidisciplinary Team Meetings: Barriers to Implementation in Cancer Care

Abstract

The multidisciplinary team meeting has become a fundamental component of cancer care across most of Europe, North America, and Australia. In certain institutions, it holds a mandatory role in the treatment planning of all patients with cancer. Although the multidisciplinary team meeting has demonstrated improved adherence to clinical protocols in the oncology field and serves as a valuable educational tool for clinicians, it is difficult to truly gauge its impact on clinical outcomes due to the wide heterogeneity in interinstitutional meeting practices and the varied data reporting clinical outcomes. This literature review will provide an overview of the history and contextual role of the multidisciplinary team meeting in cancer management and discuss the barriers to its implementation, offering means to navigate these barriers. This review will also explore the barriers to adherence to treatment recommendations offered by the multidisciplinary team meeting in cancer care, through the lens of the patient and health care provider.

Complex diseases such as cancer require a multidisciplinary approach among health care providers to tailor personalized patient care pathways. The multidisciplinary team meeting (MDTM) is central to this process,¹ providing a space for interdisciplinary health professionals to discuss patient cases and prospectively develop treatment recommendations.^2,3 Multidisciplinary tumor boards, analogous to cancer MDTMs, have occurred in the United States for more than 60 years, historically as an educational tool and later transitioning to focus on patient care aspects in the 1980s.⁴In the United Kingdom (UK), MDTMs were adopted in the 1990s to streamline cancer care coordination⁵ following public concerns regarding the widely varied cancer care practices and historically poor survival rates, as noted in the Calman-Hine report of 1995.^2,6

These reports and the subsequent National Health Service Cancer Plan of 2000⁷ encouraged a shift away from introducing new health technologies to cancer care, instead endorsing a multidisciplinary team model approach to care with an emphasis on interdisciplinary interactions among specialists.⁸ The MDTM became central to this model and has become the gold standard of cancer management in the UK.² Over the past 2 decades, many other European countries and Australia have also adopted the MDTM into cancer care.⁴ Today, the MDTM is a staple of cancer care in Europe, North America, and Australia,^4,5,9 where national guidelines including those of the UK, France, the Netherlands, United States, and Australia mandate almost all patients with cancer have their cases discussed before treatment.¹⁰ The functioning of MDTMs, however, varies widely among institutions,⁵ and this review will address important barriers to the implementation of MDTMs and the adherence to MDTM recommendations in clinical practice.

Search Methodology

Three separate search strategies: (cancer) AND (multidisciplinary meeting),” “(cancer) AND (multidisciplinary team meeting),”and “(multidisciplinary tumor board) OR (multidisciplinary tumor conference)” were performed on the PubMed website in December 2023. The eligibility criteria included original English language articles published between 2003 and 2023 focusing on adult cancer populations. Additional inclusion criteria consisted of articles providing qualitative or quantitative analysis of the barriers to cancer MDTM implementation, proposed improvements to MDTM implementation, barriers to MDTM recommendation adherence, or proposed improvements to MDTM recommendation adherence. Systematic reviews and meta-analyses on the impact of MDTMs on cancer survival outcomes were also incorporated into the inclusion criteria. Articles solely describing MDTMs in pediatric patients or benign tumor types were excluded. All commentaries were excluded.

After the removal of duplicate articles, 3351 articles resulted from the search strategy and were screened by title and abstract for eligibility, with 148 papers selected for full-text screening. After full-text screening, 97 articles met the eligibility criteria, and an additional 20 articles were included through reference extraction. Most of the selected articles were qualitative studies and mixed-method studies. The discussion of cancer MDTM benefits to survival outcomes, barriers to implementation, and barriers to treatment adherence in this review was derived from content within the 117 selected articles.

The MDTM Setting

Most MDTMs occur following a patient’s diagnosis,^5,11 often running weekly or fortnightly,¹¹ lasting 45 to 90 minutes.¹² Participants commonly include the meeting coordinator, chair, surgeons, medical and radiation oncologists, radiologists, pathologists, and cancer nurse specialists. Additional invitees may include relevant medical specialists, palliative care and nuclear medicine specialists, allied health, general practitioners, and students.^3,13 The meeting coordinator is often a cancer nurse specialist, administrative member, or senior physician who receives MDTM referrals and collates patient history and external investigations.¹²

Benefits of MDTMs

The incorporation of the MDTM into cancer care has demonstrated improved adherence to clinical guidelines.^14,15 Findings from a study by Walter et al on lung cancer MDTMs in the authors’ institution noted that more than 90% of MDTM treatment recommendations are concordant with national and international guidelines.¹⁶ Although Walter et al did not provide a comparison group of patients whose cases were managed without MDTM input, international rates of guideline adherence have been noted to vary between 35% and 65% in patients with lung cancer,¹⁷ thereby reflecting the value of MDTMs in providing guideline-based care. Similarly, Krause et al demonstrated a high guideline adherence rate (76%) of MDTM treatment recommendations for patients with gastrointestinal cancer at their institution, with the most common cause of guideline deviation explained by the inclusion of patients into clinical trials.¹⁸

The cancer MDTM also improves diagnostic accuracy.¹⁹ In a study by Newman et al of the MDTM discussions of 149 externally referred breast cancer cases, a review of external imaging by specialist breast radiologists in the MDTM resulted in alterations to 45% of previously interpreted radiologist reports, primarily involving the detection of previously missed lesions.¹⁹ Consequently, 29% of patients received recommendations for additional biopsy or changes to their subsequent imaging plans. In the same cohort, a review of external histology by specialist breast pathologists resulted in pathology interpretation changes in 29% of cases, with 9% of patients receiving changes to their surgical management due to pathologic reinterpretation.¹⁹ The MDTM, particularly with specialist radiologists and pathologists, facilitates a more thorough and expert reevaluation of previous imaging and histology slides to enhance diagnostic precision.¹⁹

Furthermore, the MDTM provides an opportunity for patients to be identified for clinical trials²⁰ and enables efficient patient care through early attention to psychosocial needs, coordination of investigations, hospital admissions, and outpatient appointments.²¹ For patients, the knowledge that their case has been discussed in an MDTM may provide reassurance that treatment recommendations are well-informed.²²

The literature largely shows improved survival outcomes when cancer MDTMs are incorporated into patient care.^20,23,24 A systematic review by Kočo et al noted significant overall survival increases in patients with colorectal, lung, or breast cancer with multidisciplinary discussions.²⁰ Among the articles selected by Kočo et al, Bydder et al compared the overall survival of patients with inoperable non–small cell lung cancer (NSCLC) with and without discussion at an MDTM, noting a statistically significant (log-rank P = .048) higher mean survival of 280 days in the cohort discussed in an MDTM compared with 205 days in the cohort not discussed.²⁵ Furthermore, Ye et al documented a significantly improved overall survival (OS) in patients with colorectal cancer discussed at the MDTMs with log-rank P = .015, where patients whose cases underwent management after MDTM implementation demonstrated 1-, 3-, and 5-year survival rates of 95.8%, 87.1%, and 79.1%, respectively, compared with 94.5%, 75.7%, and 62.4% in patients whose cases were not discussed in the MDTM.²⁶

Also discussed by the review was a large-scale study by Yang et al comparing survival outcomes in 3681 patients with early-stage breast cancer according to MDTM treatment recommendation adherence vs nonadherence. After a mean follow-up period of 32.75 months, a significantly higher estimated disease-free survival (93.89% vs 89.69%; P <.001) was calculated for the MDTM treatment recommendation–adherent group compared with the nonadherent group, with a significantly higher estimated 3-year OS (98.98% in the MDTM treatment recommendation adherent group vs 97.19% in the nonadherent group, P <.001).²⁷ Pooled meta-analysis data by de Castro et al has also identified a significantly improved OS in patients with NSCLC discussed in the MDTM compared with those without MDTM discussion.²⁴ A meta-analysis by Algwaiz et al of 5 articles assessing MDTM outcomes in colorectal cancer, head and neck squamous cell carcinoma, colorectal liver metastasis, gastrointestinal cancer, and rectal cancer identified improved 5-year survival rates in the patients whose cases were discussed in MDTMs, with a pooled OR of 0.59 for 5-year death rates.²³

Despite the commonality of MDTMs, more supporting literature assessing patient outcomes and cost-benefit analyses is needed, ideally stratified to cancer type and meeting processes. There is currently an unequal distribution of cancer types studied concerning patient outcomes following the incorporation of multidisciplinary discussion. Among the most common cancer types, for example, there is a literature gap in prostate cancer outcomes with MDTM incorporation.²⁰ Although the available literature largely supports MDTMs, some studies have noted negligible improvement in team decision-making²⁸ and survival outcomes.²⁹ Creating study designs assessing MDTM outcomes is difficult, due to the heterogeneity of meeting processes and evolving treatments that confound outcomes.³⁰ Furthermore, randomized controlled trials often cannot be conducted, as the MDTM is now a standard of care across many countries.³¹

The MDTM also confers benefits to health professionals. For staff, it is an educational platform for introducing emerging treatments and clinical trials, and the meeting format can foster good professional relationships.^21,32 Through the establishment of MDTM treatment recommendations, staff may also feel more supported in their management plans.³²

Barriers to Multidisciplinary Meeting Implementation

Although a well-operating MDTM improves patient care and professional development, a deterioration of decision-making in the MDTM renders it unproductive for implementation in cancer treatment planning, with a systematic review by Lamb et al of 37 studies showing a failure to reach consensus in 27% to 52% of MDTM cases.³³ The following sections will address the barriers to MDTM implementation as summarized in Table 1.

Summary of Barriers to MDTM Implementation

Operational Challenges

Time constraints are a common reason for the failure to reach MDTM consensus.³⁴ It is often not viable for all cases to be discussed in light of the increasing incidence of cancer.³⁵ Furthermore, centers that incorporate discussion of nonmalignant cases into their cancer MDTMs are subjected to increased caseload pressures.³⁶ Cases limited by time pressure may not receive adequate consideration of all treatment avenues, and documentation may also be cursory, not capturing the discussion details that led to the consensus.²¹ Extensive MDTM caseloads may also result in decision-making fatigue in the latter cases. An observational study by Wihl et al utilized a tumor leadership assessment instrument (ATLAS) to assign objective ratings to case presentations in a series of MDTMs averaging 18 cases each, with findings noting a consistent pattern of case presentation quality decline after case 10.³⁷

Navigating around time pressures is challenging. Focusing only on complex cases may provide a more effective context for discussion.⁵ Complex cases tend to receive more MDTM input and treatment modifications. For example, an analysis by Ryan et al noted a management change in 50% of complex cases (as defined by the preoperative management of rectal cancer, disease recurrence, metastatic disease, or malignant polyps) discussed in colorectal MDTMs compared with 3.4% in routine cases.³⁸ Findings from an observational study by Munro et al demonstrated a significant 5-year survival benefit for patients with advanced colorectal cancer discussed in the MDTM but not for those with early-stage disease.³⁹ Rare tumor types such as Merkel cell carcinoma or sarcoma may also benefit from a multidisciplinary team discussion due to complex management.²⁹ Beyond disease status, patient comorbidities, psychosocial factors, and logistical considerations also affect the complexity of the case and warrant multidisciplinary team discussion.⁴⁰ Of note, although the MDTM may be appropriate for advanced disease, patients with very poor prognoses may be excluded from MDTMs^41,42 because they are unlikely to get significant benefits from treatment.^39,42 Per caseload, case complexity, and available meeting time, each institution is advised to develop a protocol to decide which patients require MDTMs.¹³

Furthermore, preparation for MDTMs is time intensive, involving the collation of patient history and external investigations, in addition to logistical preparations. The increasing caseload over recent decades has not been met with a proportional increase in resource availability,⁴³ and staff members who spend time beyond their regular clinical duties to prepare for the meetings should be appropriately compensated.

There is emerging software that can be used to facilitate more efficient workflow in the preparation and presentation of cancer MDTM cases. For example, the NAVIFY Tumor Board is an oncology informatics software that integrates patient data from various platforms without requiring manual collation of clinical data.⁴⁴ It has demonstrated a reduction in preparation time for cancer MDTMs with increased subsequent cost-effectiveness in early studies.^45,46 NAVIFY, however, may encounter difficulties in retrieving radiology and pathology images, which are often stored within their own information systems. Furthermore, the software cannot autonomously extract pertinent images or delineate specific regions of interest within these images; that must be done manually by radiologists and pathologists.⁴⁴

In the MDTM itself, there are computerized clinical decision-support systems (CDSSs) that can be used to improve meeting efficiency.Examples include the OncoDoc2,⁴⁷ CancerLinQ,⁴⁸ and Watson for Oncology (WFO)⁴⁹ software systems. OncoDoc2 is a breast cancer CDSS that analyzes patient data to create guideline-based treatment recommendations.⁴⁷ CancerLinQ is a CDSS that utilizes rapid learning knowledge derived from electronic patient databases to deliver real-time clinical decision support.⁴⁸ WFO is an artificial intelligence–based breast cancer CDSS that integrates knowledge from medical texts and patient cases to guide clinical decision-making.⁴⁹ Computerized CDSSs ultimately improve MDTM efficiency by streamlining the decision-making process while providing treatment advice in concordance with guidelines. Computerized CDSSs, however, have drawbacks. A series of interviews conducted with MDTM participants revealed that many were unfamiliar with computerized CDSSs, with many concerned that CDSSs limit the opportunity to deviate from guideline-based treatment advice.⁵⁰ Furthermore, rapid learning CDSSs, particularly those incorporating patient data into their learning algorithms, may encounter legal issues relating to intellectual property rights and patient privacy, which may pose barriers to data sharing and widespread implementation into clinical practice.⁴⁸

Another barrier to the implementation of the MDTM as a useful treatment planning resource is lack of complete case information,⁵¹ another common reason for the failure to reach MDTM consensus.³² At times, patients’ cases are discussed in the MDTM before being medically reviewed, resulting in limited information to influence treatment planning.³² Patients with investigations conducted at external sites must have their investigations and reports transferred to the MDTM site, and patients must reliably present for additional investigations that are required before the scheduled MDTM. Radiologists and pathologists also require adequate time to interpret their findings while balancing their external commitments.⁵ As such, it is commonplace for MDTM referral deadlines to exist before meetings. However, this poses a limitation whereby new patients who narrowly miss the deadline are moved to the subsequent MDTM, which can delay the time to treatment.

Interpersonal Challenges

There often exists an implicit hierarchy in the MDTM, which can limit equal member participation. The MDTM is often led by doctors, and studies have noted less decision-making capacity for nurses.^33,43,52 Focus group interviews by Rosell et al with registered nurses unveiled significant barriers to nursing staff contribution in MDTMs.⁵³ These included the nurses’ feelings of undervaluation in MDTMs, ambiguity surrounding their roles, and barriers to attendance, such as meetings being scheduled around the physicians’ availabilities.⁵³ Results from a survey of lung cancer nurse specialists in the UK revealed only 51.7% expressed a willingness to challenge other MDTM members, whereas 19.1% found the MDTM to be an uncomfortable or intimidating experience.⁵⁴ Furthermore, an observational study by Wallace et al noted only 58 of nearly 1500 MDTM case discussions received any input from a clinical nurse specialist.55 When actively involved, nurses tend to involve psychosocial aspects and patient preferences in MDTM discussions, which are important parameters in treatment planning.⁴³ Indeed, study results have identified a general deficit in the discussion of psychosocial aspects of patient care in MDTM formats, where medicalized discussions frequently predominate over patient-centered considerations.56 Meetings are often chaired by surgical personnel,⁴³ and having a rotating leadership43 or ascribing the chairing role to the clinical nurse specialist has been suggested to be a successful means of flattening the hierarchy and increasing nursing input in MDTMs.⁵⁷

Discussion quality may also be poor if differing perspectives are not expressed due to time pressures or inferred hierarchy.⁵⁸ An Australian survey of doctors on the MDTM format noted that although 85% had disagreements with treatment recommendations, 71% did not dissent,⁵⁹ which therefore limited open communication and consequently promoted groupthink. As such, it may be useful to employ observational instruments to assess MDTM communication dynamics for better quality monitoring.⁴³

Furthermore, although the MDTM is often intended as an educational tool for residents, barriers such as time pressure, team hierarchy, and lack of familiarity with meeting regulations may prevent residents from actively engaging, thus limiting the educational value for them. To enhance residents’ proficiency in communication and collaboration during MDTM sessions, incorporating MDTM simulation training could be useful.⁶⁰ The simulation environment would allow for pauses at any point for residents to evaluate their behavioral and communication skills, whereas the fast pace of the real MDTM does not afford this opportunity.

Logistical Challenges

MDTMs cannot operate sustainably when there is poor awareness of physician medicolegal responsibilities. There are limited articles addressing the medicolegal aspects of cancer MDTMs worldwide, although there are some Australian articles dedicated to this topic. An Australian National Forum produced a consensus recommendation requiring informed consent to be obtained before MDTM discussion in Australia.61 Nevertheless, results of a survey across 51 Australian hospitals and various cancer categories by Wilcoxon et al noted that half of all patients had not consented before the MDTM discussion of their cases.⁶² Results of a survey by Rankin et al in 2016 across 7 hospitals found that verbal consent was the primary means of patient consent and was infrequently documented in medical records.⁶³ Irrespective of the country, it is recommended that all patients consent in either verbal or written form, with documentation of consent kept in the medical records.^61,63 The Australian National Forum also advised a duty of care to be conferred upon all physicians participating in the MDTM, except nonparticipating meeting members.⁶¹ However, results of an Australian survey of doctors across 18 MDTMs noted that only 48% believed in individual liability for MDTM treatment decisions, with 73% indicating their interest in further education about their legal responsibilities in MDTMs.⁶⁴ It is important for physicians to be aware of the professional liability they bear for their contributions within the MDTM. Regarding MDTM documentation, meeting members should be formally identified along with their contributions to the treatment plan.⁵⁹ Given the significant legal responsibilities of participating doctors in the MDTM, precise documentation of discussion is important. An audit in the UK revealed a high accuracy (97.1%) in the recording of MDTM treatment recommendations, which was largely attributed to the presence of a post-MDTM review process conducted by the MDTM coordinates and secretarial staff after each meeting.⁶⁵ The scribe needs to possess a medical background and be well-versed in their understanding of the investigations and management processes related to the respective oncology field. Furthermore, the scribe should be encouraged to seek clarification during the meeting in cases of ambiguity and have their documentation reviewed by the MDTM chair shortly afterward.

The virtual MDTM format has become increasingly popular since the COVID-19 pandemic.⁶⁶ Although the virtual platform eliminates the necessity of physical travel and geographical barriers for members, its smooth operation hinges greatly on robust information technology (IT) infrastructure because IT issues can delay or cancel meetings.¹¹ Institutions considering using virtual MDTMs should invest in a reliable IT setup and ensure readily available IT support during the meetings.

Barriers to MDTM Treatment Recommendation Adherence: Patient and Health Care Provider Perspectives

MDTMs coordinate holistic care, and the literature largely favors MDTMs concerning patient survival outcomes,^20,23,24 diagnostic precision, and adherence to practice guidelines,⁶⁷ where adherence is associated with improved survival.^68-70 Patient and health care professional adherence to MDTM treatment recommendations is generally high.³¹ However, the notion that MDTM treatment recommendations should always be adhered to contains nuances for exploration. The following sections will address the barriers to MDTM recommendation adherence in clinical practice through the lens of the patient and the health care professional, as summarized in Table 2.

Barriers to MDTM Recommendation Adherence

Patient Perspectives

It is important to consider reasons for nonadherence to MDTM recommendations from the patient’s standpoint. For example, patient fear of treatment toxicity can be a deterrent to recommendation adherence. Fear of treatment toxicity was a prominent reason for nonadherence to MDTM recommendations in a retrospective analysis by Samarasinghe et al of patients with breast cancer.³¹ Yang et al noted a high rate of nonadherence to chemotherapy when recommended by MDTMs in patients with breast cancer, due to fear of chemotherapy adverse effects. Patients with the luminal A disease subtype showed greater adherence to MDTM recommendations, as chemotherapy was less often recommended as a treatment modality in these patients.²⁷ Clinicians should ultimately gauge the validity of patient concerns regarding treatment toxicities and educate patients on the likelihood and severity of such toxicities in addition to ways of managing toxicities, which will better inform patient decisions.

Patient preferences may also result in nonadherence to MDTM recommendations. This was noted to be the most common cause for deviation from MDTM recommendations findings from a study by Hollunder et al of 3 multidisciplinary tumor boards⁷¹ and by Cao et al findings from a retrospective cohort study of patients with hepatocellular carcinoma (HCC), where the vast majority of patient nonadherence to MDTM recommendations occurred due to their disagreements with MDTM-suggested goals of care in that of curative vs palliative intent.⁷² Patient preferences may also be influenced by sociocultural contexts. Results of a retrospective analysis of MDTM recommendation adherence in patients with early breast cancer identified patients’ social status, psychological conditions, and caregiver status as discussion points often excluded from the MDTM. These considerations would subsequently surface in outpatient visits, potentially prompting management adjustments toward a lower intensity of care.⁷³ Furthermore, inconvenience can deter patients from engaging with MDTM recommendations. For example, patients invited to clinical trials through the MDTM are often expected to present for more rigorous follow-up, for which they may not have the resources and/or time to accommodate.³¹ As noted by Samarasinghe et al, patient pursuit of alternative therapies was a common reason for nonadherence to MDTM recommendations.³¹ Although certain patients place great value on alternative therapies due to cultural beliefs, it should be acknowledged that most alternative therapies have limited medical evidence. Such patients should be educated about this in a culturally sensitive manner.

Measures can be used to better incorporate patient perspectives into the MDTM. These include providing a pre-MDTM patient questionnaire to elicit insights into their sociocultural background and treatment preferences and integrating their responses into MDTM treatment planning. Furthermore, institutions can endorse training of MDTM members in shared decision-making and patient-centered care.⁷⁴ When the patient’s preference for treatment is unknown, the MDTM should list multiple treatment options. This approach enables more flexibility to account for the patient’s potential preferences.⁷⁵ A patient representative, such as a nurse or general practitioner, should be encouraged to participate in the MDTM to convey information about the patient’s psychosocial background and preferences. Patient attendance at the MDTM also has been suggested as a useful way for patients to self-advocate for treatment preferences; however, there are limited studies on this.^21,29 Although patient participation largely amounted to positive patient and health care professional experiences in findings from a pilot study by Choy et al,⁷⁶ Butow et al noted strong physician apprehension toward the inclusion of patients in their MDTMs. These physicians expressed concerns of inducing patient anxiety and the need to use lay
language that limits professional dialogue, thereby slowing meeting progression.⁷⁷ As such, the decision regarding patient participation in case discussions should be at the discretion of the institution.

Health Care Professional Perspectives

When MDTMs lack important clinical information, are subjected to time pressure or IT issues, or are missing core team members, the resultant treatment consensus may be misinformed and unsuitable for patients.⁴³ Information realized after the MDTM, such as new or unexpected clinical findings, may prompt the primary treating physician to alter the treatment plan. For example, patients recommended for surgery by the MDTM consensus may later be deemed unfit for surgery, so an anesthetist’s presence in the MDTM to discuss fitness for surgery may be of benefit.⁴³

MDTMs can misjudge the feasibility of certain procedures. As noted by Cao et al, some patients with HCC in their study were unable to undertake MDTM-recommended surgery or ablation because of tumor locations that were later found to be too difficult for surgical or ablative access.⁷² Although patients should consent to and commence treatment soon after the MDTM, a lack of resources and staffing may result in treatment delays, and as acknowledged by Cao et al, tumors such as those in HCC can rapidly progress between the time of the MDTM and the time of initial treatment, so patients may no longer be appropriate for the recommended treatment.⁷² Similarly, poor judgment of patient conditioning in the MDTM can force a deviation from MDTM recommendations if aggressive therapy is not appropriate for the patient due to deconditioning or comorbidity profiles.⁷⁸

Conclusion

The multidisciplinary meeting confers important value to the landscape of cancer care, serving to optimize treatment planning and patient outcomes. A successful MDTM hinges upon several factors, including adequate time allocation, comprehensiveness of clinical data, effective team collaboration, and well-organized logistics. Focusing on complex cases can improve meeting efficiency, and setting referral deadlines will ensure adequate time for comprehensive data gathering. Introducing workflow and decision-making software can also improve meeting efficiency. Such software has recently come to adopt rapid learning and artificial intelligence technology, for which there is further scope for interventional studies to assess their accuracy and efficacy. Regarding team dynamics, a flattened hierarchy should be embraced across all MDTMs to optimize multidisciplinarity. To improve adherence to MDTM recommendations, care teams should address sociocultural considerations and patient fears and preferences for treatment. Similarly, physicians should ensure an accurate presentation of clinical details of the patient and their disease profile to allow for feasible recommendations to result. Due to the variations in MDTM practices across institutions, audits within institutions are advised to assess MDTM quality with stratification to cancer type concerning clinical outcomes, member satisfaction, and adherence to MDTM recommendations.

References

1. Agostinelli V, Cognigni V, Lunerti V, et al. Diagnostic and therapeutic care pathways of cancer patients: a model of multidisciplinary management and patient-tailored healthcare at University Hospital in Italy. Hospital Administration and Medical Practices. 2022;1. doi:10.54844/hamp.2022.0027
2. Soukup T, Stewart GD, Lamb BW. Defining an evidence-based strategy for streamlining cancer multidisciplinary team meetings. Lancet Oncol. 2023;24(10):1061-1063.doi:10.1016/S1470-2045(23)00440-0
3. Singhi EK, Feldman J, West HJ. The multidisciplinary cancer conference. JAMA Oncol. 2023;9(2):288. doi:10.1001/jamaoncol.2022.4924
4. Patkar V, Acosta D, Davidson T, Jones A, Fox J, Keshtgar M. Cancer multidisciplinary team meetings: evidence, challenges, and the role of clinical decision support technology. Int J Breast Cancer. 2011;2011:831605. doi:10.4061/2011/831605
5. Winters DA, Soukup T, Sevdalis N, Green JSA. The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives. BJU Int. 2021;128(3):271-279. doi:10.1111/bju.15495
6. Whitehouse M. A policy framework for commissioning cancer services. BMJ. 1995;310(6992):1425-1426. doi:10.1136/bmj.310.6992.1425
7. The NHS Cancer Plan: a progress report. The House of Commons Committee of Public Accounts. 2000. Accessed July 23, 2024. https://publications.parliament.uk/pa/cm200506/cmselect/cmpubacc/791/791.pdf
8. Morris E, Haward RA, Gilthorpe MS, Craigs C, Forman D. The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire’s colorectal cancer patients. Br J Cancer. 2006;95(8):979-985. doi:10.1038/sj.bjc.6603372
9. Wright FC, De Vito C, Langer B, Hunter A; Expert Panel on Multidisciplinary Cancer Conference Standards. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007;43(6):1002-1010. doi:10.1016/j.ejca.2007.01.025
10. Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res. 2022;22(1):829. doi:10.1186/s12913-022-08112-0
11. Soukup T, Lamb BW, Morbi A, et al. Cancer multidisciplinary team meetings: impact of logistical challenges on communication and decision-making. BJS Open. 2022;6(4)zrac093. doi:10.1093/bjsopen/zrac093
12. Planning a multidisciplinary care meeting. Cancer Australia. 2024. Accessed July 23, 2024. https://www.canceraustralia.gov.au/clinicians-hub/multidisciplinary-care/all-about-multidisciplinary-care/planning-multidisciplinary-care-meeting
13. Multidisciplinary meetings for cancer care: a guide for health service providers. National Breast and Ovarian Cancer Centre. 2005. Accessed July 23, 2024. https://www.canceraustralia.gov.au/sites/default/files/publications/mdm-mdc-meeting-for-cancer-care_504af02d7368d.pdf
14. Conron M, Phuah S, Steinfort D, Dabscheck E, Wright G, Hart D. Analysis of multidisciplinary lung cancer practice. Intern Med J. 2007;37(1):18-25. doi:10.1111/j.1445-5994.2006.01237.x
15. Vinod SK, Sidhom MA, Delaney GP. Do multidisciplinary meetings follow guideline-based care? J Oncol Pract. 2010;6(6):276-281. doi:10.1200/JOP.2010.000019
16. Walter J, Moeller C, Resuli B, et al. Guideline adherence of tumor board recommendations in lung cancer and transfer into clinical practice. J Cancer Res Clin Oncol. 2023;149(13):11679-11688. doi:10.1007/s00432-023-05025-1
17. Bierbaum M, Rapport F, Arnolda G, et al. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: a systematic review. Asia Pac J Clin Oncol. 2023;19(6):618-644. doi:10.1111/ajco.13948
18. Krause A, Stocker G, Gockel I, et al. Guideline adherence and implementation of tumor board therapy recommendations for patients with gastrointestinal cancer. J Cancer Res Clin Oncol. 2023;149(3):1231-1240. doi:10.1007/s00432-022-03991-6
19. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107(10):2346-2351. doi:10.1002/cncr.22266
20. Kočo L, Weekenstroo HHA, Lambregts DMJ, et al. The effects of multidisciplinary team meetings on clinical practice for colorectal, lung, prostate and breast cancer: a systematic review. Cancers (Basel). 2021;13(16):4159. doi:10.3390/cancers13164159
21. Devitt B, Philip J, McLachlan SA. Team dynamics, decision making, and attitudes toward multidisciplinary cancer meetings: health professionals’ perspectives. J Oncol Pract. 2010;6(6):e17-e20. doi:10.1200/JOP.2010.000023
22. Devitt B, Philip J, Singh M, McLachlan SA. Understanding patients’ attitudes toward cancer multidisciplinary meetings: a mixed methods study. JCO Oncol Pract. 2020;16(2):e175-e182. doi:10.1200/JOP.19.00274
23. Algwaiz G, Salam Y, Bustami R, Ferwana M, Jazieh AR. Do multidisciplinary tumor board discussions correlate with increase in 5-year survival? A meta-analysis study. Glob J Qual Saf Healthc. 2020;4(1):3-10. doi:10.36401/JQSH-20-23
24. de Castro G Jr, Souza FH, Lima J, Bernardi LP, Teixeira CHA, Prado GF; Grupo Brasileiro de Oncologia Torácica (GBOT). Does multidisciplinary team management improve clinical outcomes in NSCLC? A systematic review with meta-analysis. JTO Clin Res Rep. 2023;4(12):100580. doi:10.1016/j.jtocrr.2023.100580
25. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern Med J. 2009;39(12):838-841. doi:10.1111/j.1445-5994.2009.02019.x
26. Ye YJ, Shen ZL, Sun XT, et al. Impact of multidisciplinary team working on the management of colorectal cancer. Chin Med J (Engl). 2012;125(2):172-177.
27. Yang X, Huang J, Zhu X, Shen K, Zhu J, Chen X. Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: an analysis of 4501 consecutive patients. Breast. 2020;52:135-145. doi:10.1016/j.breast.2020.05.008
28. Kee F, Owen T, Leathem R. Decision making in a multidisciplinary cancer team: does team discussion result in better quality decisions? Med Decis Making. 2004;24(6):602-613. doi:10.1177/0272989X04271047
29. Berardi R, Morgese F, Rinaldi S et al. Benefits and limitations of a multidisciplinary approach in cancer patient management. Cancer Manag Res. 2020;12:9363-9374. doi:10.2147/CMAR.S220976
30. Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JSA. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol. 2012;23(5):1293-1300. doi:10.1093/annonc/mdr453
31. Samarasinghe A, Chan A, Hastrich D, et al. Compliance with multidisciplinary team meeting management recommendations. Asia Pac J Clin Oncol. 2019;15(6):337-342. doi:10.1111/ajco.13240
32. Rosell L, Alexandersson N, Hagberg O, Nilbert M. Benefits, barriers and opinions on multidisciplinary team meetings: a survey in Swedish cancer care. BMC Health Serv Res. 2018;18(1):249. doi:10.1186/s12913-018-2990-4
33. Lamb BW, Brown KF, Nagpal K, Vincent C, Green JAS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18(8):2116-2125. doi:10.1245/s10434-011-1675-6
34. Lamprell K, Arnolda G, Delaney GP, Liauw W, Braithwaite J. The challenge of putting principles into practice: resource tensions and real-world constraints in multidisciplinary oncology team meetings. Asia Pac J Clin Oncol. 2019;15(4):199-207. doi:10.1111/ajco.13166
35. Global cancer burden growing, amidst mounting need for services. World Health Organization. February 1, 2024. Accessed July 23, 2024. https://shorturl.at/X8VJ7
36. Soukup T, Murtagh G, Lamb BW, Green JSA, Sevdalis N. Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: conversation analysis. J Multidiscip Healthc. 2021;14:411-424. doi:10.2147/JMDH.S270394
37. Wihl J, Rosell L, Frederiksen K, Kinhult S, Lindell G, Nilbert M. Contributions to multidisciplinary team meetings in cancer care: predictors of complete case information and comprehensive case discussions. J Multidiscip Healthc. 2021;14:2445-5242. doi:10.2147/JMDH.S309162
38. Ryan J, Faragher I. Not all patients need to be discussed in a colorectal cancer MDT meeting. Colorectal Dis. 2014;16(7):520-526. doi:10.1111/codi.12581
39. Munro A, Brown M, Niblock P, Steele R, Carey F. Do multidisciplinary team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience. BMC Cancer. 2015;15:686. doi:10.1186/s12885-015-1683-1
40. Soukup T, Morbi A, Lamb BW, et al. A measure of case complexity for streamlining workflow in multidisciplinary tumor boards: mixed methods development and early validation of the MeDiC tool. Cancer Med. 2020;9(14):5143-5154. doi:10.1002/cam4.3026
41. Rollet Q, Bouvier V, Moutel G, et al. Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival - a registry-based study. BMC Health Serv Res. 2021;21(1):1032. doi:10.1186/s12913-021-07022-x
42. Walraven JEW, Ripping TM, Oddens JR, et al. The influence of multidisciplinary team meetings on treatment decisions in advanced bladder cancer. BJU Int. 2023;131(2):244-252. doi:10.1111/bju.15856
43. Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JSA. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc. 2018;11:49-61. doi:10.2147/JMDH.S117945
44. Krupinski EA, Comas M, Gallego LG; GISMAR Group. A new software platform to improve multidisciplinary tumor board workflows and user satisfaction: a pilot study. J Pathol Inform. 2018;9:26. doi:10.4103/jpi.jpi_16_18
45. Hammer RD, Fowler D, Sheets LR, Siadimas A, Guo C, Prime MS. Digital tumor board solutions have significant impact on case preparation. JCO Clin Cancer Inform. 2020;4:757-768. doi:10.1200/CCI.20.00029
46. Hammer RD, Srinivas S, Rajendran S, Guo C, Prime MS. Economic impact of digital tumor board software: an evaluation of cost savings using real-world data. J Clin Oncol. 2022;40(suppl 16):e18794. doi:10.1200/JCO.2022.40.16_suppl.e18794
47. Séroussi B, Bouaud J, Gligorov J, Uzan S. Supporting multidisciplinary staff meetings for guideline-based breast cancer management: a study with OncoDoc2. AMIA Annu Symp Proc. 2007;2007:656-660.
48. Rubinstein SM, Warner JL. CancerLinQ: origins, implementation, and future directions. JCO Clin Cancer Inform. 2018;2:1-7. doi:10.1200/CCI.17.00060
49. Somashekhar SP, Sepúlveda MJ, Puglielli S, et al. Watson for Oncology and breast cancer treatment recommendations: agreement with an expert multidisciplinary tumor board. Ann Oncol. 2018;29(2):418-423. doi:10.1093/annonc/mdx781
50. Walraven JEW, Verhoeven RHA, van der Hoeven JJM, et al. Pros and cons of streamlining and use of computerised clinical decision support systems to future-proof oncological multidisciplinary team meetings. Front Oncol. 2023;13:1178165. doi:10.3389/fonc.2023.1178165
51. Lanceley A, Savage J, Menon U, Jacobs I. Influences on multidisciplinary team decision-making. Int J Gynecol Cancer. 2008;18(2):215-222. doi:10.1111/j.1525-1438.2007.00991.x
52. Horlait M, Baes S, Dhaene S, Van Belle S, Leys M. How multidisciplinary are multidisciplinary team meetings in cancer care? An observational study in oncology departments in Flanders, Belgium. J Multidiscip Healthc. 2019;12:159-167. doi:10.2147/JMDH.S196660
53. Rosell L, Melander W, Lindahl B, Nilbert M, Malmström M. Registered nurses’ views on consideration of patient perspectives during multidisciplinary team meetings in cancer care. BMC Nurs. 2022;21(1):350. doi:10.1186/s12912-022-01127-2
54. Stewart I, Leary A, Tod A, et al. Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit. Eur J Oncol Nurs. 2018;36:103-111. doi:10.1016/j.ejon.2018.07.006
55. Wallace I, Barratt H, Harvey S, Raine R. The impact of clinical nurse specialists on the decision making process in cancer multidisciplinary team meetings: a qualitative study. Eur J Oncol Nurs. 2019;43:101674. doi:10.1016/j.ejon.2019.101674
56. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. doi:10.1016/j.ctrv.2015.11.007
57. McGlynn B, Johnston M, Green J. A nurse-led multidisciplinary team approach in urology-oncology: addressing the new cancer strategy. Journal of Clinical Urology. 2017;10(5):449-456. doi:10.1177/2051415817700034
58. Lamb BW, Taylor C, Lamb JN, et al. Facilitators and barriers to teamworking and patient centeredness in multidisciplinary cancer teams: findings of a national study. Ann Surg Oncol. 2013;20(5):1408-1416. doi:10.1245/s10434-012-2676-9
59. Karas PL, Rankin NM, Stone E. Medicolegal considerations in multidisciplinary cancer care. JTO Clin Res Rep. 2020;1(4):100073. doi:10.1016/j.jtocrr.2020.100073
60. Walraven JEW, van der Meulen R, van der Hoeven JJM, et al. Preparing tomorrow’s medical specialists for participating in oncological multidisciplinary team meetings: perceived barriers, facilitators and training needs. BMC Med Educ. 2022;22(1):502. doi:10.1186/s12909-022-03570-w
61. Evans AC, Zorbas HM, Keaney MA, Sidhom MA, Goodwin HE, Peterson JC. Medicolegal implications of a multidisciplinary approach to cancer care: consensus recommendations from a national workshop. Med J Aust. 2008;188(7):401-404. doi:10.5694/j.1326-5377.2008.tb01684.x
62. Wilcoxon H, Luxford K, Saunders C, Peterson J, Zorbas H; National Breast and Ovarian Cancer Centre's Multidisciplinary Care Audit Steering Committee. Multidisciplinary cancer care in Australia: a national audit highlights gaps in care and medico-legal risk for clinicians. Asia Pac J Clin Oncol. 2011;7(1):34-40. doi:10.1111/j.1743-7563.2010.01369.x
63. Rankin NM, Lai M, Miller D, et al. Cancer multidisciplinary team meetings in practice: results from a multi-institutional quantitative survey and implications for policy change. Asia Pac J Clin Oncol. 2018;14(1):74-83. doi:10.1111/ajco.12765
64. Sidhom MA, Poulsen M. Group decisions in oncology: doctors’ perceptions of the legal responsibilities arising from multidisciplinary meetings. J Med Imaging Radiat Oncol. 2008;52(3):287-292. doi:10.1111/j.1440-1673.2007.01916.x
65. De Ieso PB, Coward JI, Letsa I, et al. A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology. Br J Cancer. 2013;109(9):2295-2300. doi:10.1038/bjc.2013.586
66. Zhang Y, Li J, Liao M, et al. Cloud platform to improve efficiency and coverage of asynchronous multidisciplinary team meetings for patients with digestive tract cancer. Front Oncol. 2023;13:1301781. doi:10.3389/fonc.2023.1301781
67. Lamb BW, Green JS, Benn J, Brown KF, Vincent CA, Sevdalis N. Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients. J Am Coll Surg. 2013;217(3):412-420. doi:10.1016/j.jamcollsurg.2013.04.035
68. Ricci-Cabello I, Vásquez-Mejía A, Canelo-Aybar, C et al. Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries. BMC Health Serv Res. 2020;20(1):920. doi:10.1186/s12913-020-05753-x
69. Abrams RA, Winter KA, Regine WF, et al. Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704--a phase III trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys. 2012;82(2):809-816. doi:10.1016/j.ijrobp.2010.11.039
70. Boland GM, Chang GJ, Haynes AB, et al. Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer. Cancer. 2013;119(8):1593-1601. doi:10.1002/cncr.27935
71. Hollunder S, Herrlinger U, Zipfel M, et al. Cross-sectional increase of adherence to multidisciplinary tumor board decisions. BMC Cancer. 2018;18(1):936. doi:10.1186/s12885-018-4841-4
72. Cao Y, Mezzacappa C, Jaffe A, Strazzabosco M, Taddei TH. Adherence to tumor board recommendations in the treatment of patients with hepatocellular carcinoma. J Multidiscip Healthc. 2023;16:1531-1540. doi:10.2147/JMDH.S407908
73. Bortot L, Targato G, Noto C, et al. Multidisciplinary team meeting proposal and final therapeutic choice in early breast cancer: is there an agreement? Front Oncol. 2022;12:885992. doi:10.3389/fonc.2022.885992
74. Geerts PAF, van der Weijden T, Savelberg W, et al. The next step toward patient-centeredness in multidisciplinary cancer team meetings: an interview study with professionals. J Multidiscip Healthc. 2021;14:1311-1324. doi:10.2147/JMDH.S286044
75. Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings. PLoS One. 2015;10(10):e0139921. doi:10.1371/journal.pone.0139921
76. Choy ET, Chiu A, Butow P, Young J, Spillane A. A pilot study to evaluate the impact of involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Breast. 2007;16(2):178-189. doi:10.1016/j.breast.2006.10.002
77. Butow P, Harrison JD, Choy ET, Young JM, Spillane A, Evans A. Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer. 2007;110(9):1937-1944. doi:10.1002/cncr.23007
78. Ring A, Harder H, Langridge C, Ballinger RS, Fallowfield LJ. Adjuvant chemotherapy in elderly women with breast cancer (AChEW): an observational study identifying MDT perceptions and barriers to decision making. Ann Oncol. 2013;24(5):1211-1219. doi:10.1093/annonc/mds642