Background
Multidisciplinary cancer team meetings are intended to optimize the diagnosis of a patient with a malignancy. The aim of this study was to assess the number of correct diagnoses formulated ...by the multidisciplinary team (MDT) and whether MDT decisions were implemented.
Methods
In a prospective study, data of consecutive patients discussed at gastrointestinal oncology MDT meetings were studied, and MDT diagnoses were validated with pathology or follow-up. Factors of influence on the correct diagnosis were identified by use of a Poisson regression model. Electronic patient records were used to assess whether MDT decisions were implemented, and reasons to deviate from these decisions were hand-searched within these records.
Results
In 74 MDT meetings, 551 patients were discussed a total of 691 times. The MDTs formulated a correct diagnosis for 515/551 patients (93.4 %), and for 120/551 (21.8 %) patients the MDT changed the referral diagnosis. Of the MDT diagnoses, 451/515 (87.6 %) were validated with pathology. Patients presented to the MDT by their treating physician were 20 % more likely to receive a correct diagnosis relative risk (RR) 1.2, 95 % confidence interval (CI) 1.1–1.5, while the number of patients discussed or the duration of the meeting had no influence on this (RR 1.0, 95 % CI 0.99–1.0; RR 1.0, 95 % CI 0.9–1.1; resp.). MDT decisions were implemented in 94.4 % of cases. Deviations of MDT decisions occurred when a patient’s wishes or physical condition were not taken into account.
Conclusions
MDTs rectify 20 % of the referral diagnoses. The presence of the treating physician is the most important factor to ensure a correct diagnosis and adherence to the treatment plan.
Abstract only
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Background: Multidisciplinary team meetings (MDM) provide a platform for discussing diagnoses and treatments. Since many healthcare settings have accepted multidisciplinary care as ...best practice, avenues towards improving MDMs should be investigated. This study aimed to identify variables that influence the efficiency and efficacy of an MDM in a tertiary referral center in the Netherlands. Methods: Consecutive MDMs for hepatocellular carcinoma (HCC), colorectal carcinoma (CRC), esophageal and gastric cancer (ESOGAS) and pancreatobiliary and liver cancer (HPB) were studied. Efficiency was measured as duration of the MDM. Efficacy was assessed by accurate diagnoses. Logistic and linear regression models identified variables influencing the efficiency and efficacy. Results: In 74 MDMs with a mean duration of 63 min (SD 14), 700 patients were discussed of which 114 patients at ≥2 MDMs. A median of 10 patients was discussed per MDM (IQR 6 – 14). Mean discussion time per patient was 05:19 min (SD 2). Corrected for tumor type, the number of patients discussed and the presence of others (e.g., research fellows) in addition to medical specialists, prolonged the MDM (+1.9 min CI 1.2 – 2.6; +0.64 min; CI 0.23 – 1.5 resp.). Including a follow up patient in the MDM, decreased the duration by 3.9 min (CI -5.8 – -2.0). The diagnostic accuracy of the MDM was 95%. The duration of the MDM or number of patients discussed did not influence this (OR 1.1 CI 0.99 – 1.0; OR 0.92 CI 0.79 – 1.1 resp.). The diagnosis was accurately altered for 117 (21%) patients, for 1 patient it was altered incorrectly. Tumor type predicted the accurate diagnoses (OR 0.1 CI 0.02 – 0.71; OR 2.0 CI 0.46 – 8.6; OR 3.1 CI 1.3 – 7.4; for HCC, CRC and ESOGAS respectively. Reference group: HPB). A correct diagnosis was more likely if patients’ cases were presented by their own doctor (OR 5.0 CI 2.0 – 12.5). Conclusions: MDMs play a crucial role in oncology management. For 21% of patients the diagnosis was correctly altered by the MDM. The diagnostic accuracy of the MDM was 95%. The absence of a presenting doctor decreased this accuracy while duration of MDM and number of patients discussed did not affect this accuracy. The presence of research fellows prolonged the duration of the MDM.
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