Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments

• Published in: Annals of surgical oncology Vol. 18; no. 13; pp. 3535 - 3543
• Main Authors: Lamb, B. W., Sevdalis, N., Mostafid, H., Vincent, C., Green, J. S. A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-12-2011; Springer Nature B.V
• Subjects: Decision Making; Healthcare Policy and Outcomes; Humans; Interdisciplinary Studies; Medical Oncology - organization & administration; Medicine; Medicine & Public Health; Neoplasms - therapy; Oncology; Patient Care Team - organization & administration; Practice Patterns, Physicians' - organization & administration; Quality Improvement; Quality of Health Care - standards; Surgery; Surgical Oncology; Observational Assessment; Terpstra Test; Team Behavior; Observational Tool; Team Performance
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1773-5

Purpose
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.
Results
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).
Conclusions
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.