The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment ...decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.
A timely integrated diagnostic and care trajectory for children with a developmental disability may prevent severe problems in later life. In Flanders, Belgium, different types of governmental ...regulated and subsidised settings offer diagnostic evaluations, as (part of) their mission. However, they operate in a non-coordinated way inducing severe accessibility problems for the public. This article studies the factors impacting on interorganisational collaboration and proposes an interorganisational conceptual model improving accessibility.
Focus groups were performed per type of organisation. Qualitative data were categorised thematically in an iterative process of data- and researcher triangulation. A member check validation was organised.
Fifty-nine individuals participated in 6 focus groups. Structural and agency-related barriers for interorganisational collaboration were identified at micro, meso and macro level. Participants provided suggestions for better interorganisational collaboration.
To improve accessibility adapted to patients' needs, a patient-centred, integrated and interorganisational network model grounded in a stepped care logic is proposed to adapt the current organisation-centred model.
A timely, integrated, diagnostic and care trajectory for children with a developmental disability preventing severe problems in later life requires an integration of services during the overall care trajectory of children by means of interorganisational collaboration.
Introduction: Multidisciplinary interprofessional, interorganizational and intersectoral collaboration is considered key to meet the complex needs of persons with an autism spectrum disorder (ASD). ...However, the “institutional field” potentially challenges the integration of care for persons with ASD in Flanders. This contribution explores how regulations affect adequate trajectories of care for persons with ASD. Methods: An inventory was made of publicly accredited and funded organisations providing (early) detection, diagnostics, treatment and care for children, adolescents and adults with ASD. A qualitative thematic analysis was done of the criteria put forward by Federal and Flanders’ Community/Regional regulations for organisations. This analysis was validated and complemented with information from an expert panel in order to understand barriers and facilitators for collaboration. Results: The inventory learns that more types of organisations in different policy domains provide services for children and adolescents with ASD compared to adults. The regulations setting the criteria for target group, type of ASD related activity, the professional team, access (financial and by referral or not) and organizational characteristics differ according to the sector (health, welfare, persons with disability). The regulations also differ in the level of detail of criteria. Some organisations (and regulations) are dedicated for persons with ASD, while other organisations provide services for a wider range of disorders, including ASD. Discussion: After the 6th state reform in Belgium, Flanders is seeking for an interorganizational collaboration model providing ASD services. This project studies the possibilities for a “mandated interorganizational network” in which general and specialized care are provided in an effective and efficient way, including an accessible regional system of care for persons with ASD. Therefore we need to understand the newly emerging institutional field. At this stage we only performed a rather formalistic thematic analysis of the regulatory conditions. This needs be complemented with a more in depth understanding the cultural-cognitive and the normative characteristics of the field impacting on real life practices of collaboration. Many indications are found that , if any, collaborations are mainly informal and rely very much on the personal social network of the professionals involved in ASD. Conclusion: At this stage, regulatory frameworks setting the criteria for organisations providing services in ASD trajectories are not entirely aligned, which will hamper to develop a framework for a mandated network. Further reflections are needed to set the scope of a mandated ASD network Lessons learned: Regulatory frameworks of different policy fields within a complex political organisation affect how a model can be developed to implement a mandated network. Regulatory frameworks do not explicitly define if services are “general” or “specialized and dedicated” for ASD. Further reflections are needed on how to regionally organize a balanced and integrated model of care. Limitations: This paper is limited to a rather formalistic thematic analysis of formal regulations. Suggestions for future research: More “realistic evaluation” is needed on the hampering and facilitating factors of interprofessional and multidisciplinary collaboration.
Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, ...limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making.
This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM's results.
For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design.
The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022.
The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups.
PRR1-10.2196/29004.
Introduction: Multidisciplinary team meetings (MDTMs) are considered best practice in the management and decision-making for cancer patients. The team typically consists of surgeons, medical ...oncologists, organ specialists, radiologists, pathologists and in some cases oncology specialist nurses and psychologists. They aim at evidence-based, collaborative and multidisciplinary decision-making for cancer treatment and patient management. In Belgium, the multidisciplinary approach is mandatory and formally regulated since 2003. When the Belgian Cancer Plan was launched in 2008 a specific professional group was included in this policy plan: the onco-psychologists. Preliminary study results in Flanders show that onco-psychologists do not systematically attend the MDTMs, while the results also reveal that, in addition to the oncology specialist nurses, they may facilitate the uptake of psychosocial information. To ensure that MDTMs can benefit from their diverse membership to achieve their full potential, significant attention should be devoted to the attendance and active participation of the non-medical disciplines during these meetings. The aim of this study is to explore and describe 1) the multidisciplinary character of MDTMs and 2) the (possible) role of the onco-psychologists to enhance the uptake of psychosocial information during the MDTMs. Methods: This contribution presents an observational study. 59 MDTMs are observed at inpatient medical oncology departments in five different Belgian hospitals (academic as well as general). Results: The findings align with previous studies arguing that MDTMs in oncology are typically driven by doctors, with limited input of onco-psychologists and other nonmedical staff and that decisions are based on biomedical information with far less consideration of psychosocial information. Discussion: A MDTM should not merely be a group of care professionals who work essentially independently and occasionally liase with one another. From these findings we argue that onco-psychologists can potentially bridge the gap between medical and non-medical members of the team becoming an “additional mechanism” to enhance the uptake of psychosocial aspects in treatment decisions. Lessons Learned: This study shows a worryingly low awareness of the true character of multidisciplinarity, particularly among medical disciplines in oncology care. Efforts should be made to change the working culture towards a truly integrated care approach among professionals in oncology. Limitations: The purposive sampling of inpatient medical oncology departments within two academic hospitals and three non-academic hospitals in one country, limits the generalizability of the results for broader organizational contexts and health systems. Suggestions for future research: More empirical studies are needed to reveal the reasons why MDTMs fail to fully integrate all disciplines. Also, more empirical evidence to understand how team composition, hospital culture and organizational or environmental factors can either directly affect MDTM performance or serve as key mediators to its success is needed. Lastly, interventions aiming to support the role of the onco-psychologists are crucial to enhance the input of psychosocial information.
Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility ...problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field.
Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized.
Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory.
Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.
In evidence-informed policy-making (EIP), major knowledge gaps remain in understanding the context and possibilities for institutionalisation of knowledge translation. In 2014, the WHO ...Evidence-informed Policy Network (EVIPNet) Europe initiated a number of pilot countries, with Hungary among them, to engage in a 'situation analysis' (SA) in order to fill some of those gaps. This contribution discusses the results of the SA in Hungary on research-policy interactions, facilitating factors and potential barriers to establish a knowledge translation platform (KTP).
In line with the EVIPNet Europe SA Manual, a document analysis, 13 interviews, 3 focus group discussions with 21 participants, and an online survey with 31 respondents were carried out from April to October, 2015. A SA aims to assess the context in which EIP takes form and seeks opportunities to establish a KTP, so information was gathered on the current practice of EIP and knowledge translation, its relevant actors, enablers and barriers for EIP, and opinions on a future KTP. Methodological and researcher triangulation resulted in a narrative synthesis of data, including a comparison with literature. A stakeholder consultation was organised to validate findings.
This study reveals that stakeholders show commitment to produce and use research evidence in Hungarian health policy-making. All stakeholders endorsed the idea of strengthening the systematic use of evidence in decision-making and favoured the idea of establishing a KTP. In line with literature on other countries, some good practices exist on the uptake of evidence in policy-making; however, a systematic approach of developing, translating and using research evidence in health policy processes is lacking. EIP is currently hampered by scattered capacity, coordination problems, high fluctuation in government, an often legalistic and a more 'symbolic' rather than practical support for knowledge translation and EIP. The article summarises recommendations on a Hungarian KTP.
Pragmatic adaptation of the SA Manual to local needs proved to be a useful mechanism to provide insight into the Hungarian EIP field and the establishment of a potential KTP. Despite the success of a KTP pilot, it remains unclear how a KTP in Hungary will be institutionalised in a sustainable way.
Aim
To clarify organizational perspectives on diagnostic evaluations for children with neurodevelopmental disorders (NDD), with the goal to enhance interorganizational collaboration and improve ...accessibility.
Method
Focus groups with expert stakeholders in Flanders, Belgium, were organized. Data were analyzed in a continuous, comparative method with researcher and data triangulation, and a member check validation.
Results
Fifty‐nine people participated in six focus groups. Organizations had no shared vision on diagnostic evaluations of NDD. An interdisciplinary team approach was considered essential. All stakeholders agreed that a diagnostic evaluation is an iterative process along the trajectory of the child.
Interpretation
Diagnostic evaluations of NDD should be conceptualized as an integrated process of the child’s care trajectory, differentiating needs‐based goals in each phase, and requiring an interdisciplinary team approach. This conceptualization will support a health systems model, allowing interorganizational collaboration to optimize available capacity and increase accessibility.
This original article is commented by Binagwaho and Muvunyi on page 12 of this issue.
This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness trajectories at NICU.
...Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990-March 2008.
The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention.
In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents.
Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals.
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