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Introduction: Functional perspective of team decision-making highlights the importance of understanding the relationship between team interaction/communication during a given task, the internal factors that emanate from within a group (e.g., team composition), and the external circumstances (e.g., workload and time pressures). As an underexplored area, we explored these relationships in the context of multidisciplinary team (MDT) meetings (aka tumor boards). Materials and methods: Three cancer MDTs with 44 team members were recruited from three teaching hospitals in the United Kingdom. Thirty of their weekly meetings encompassing 822 case reviews were filmed. Validated instruments were used to assess each case: Bales' Interaction Process Analysis that captures frequency of task-oriented and socio-emotional interactions/communication; and Measure of case-Discussion Complexity that captures clinical and logistic complexities. We also measured team size, disciplinary diversity, gender, time-workload pressure, and time-on-task. Partial correlation analysis controlling for team/tumor type and case complexity was used for analysis. Results: Clinical complexity positively correlated with task-oriented communication, e.g., gives opinion (r = 0.51, p < 0.001), and logistical issues with negative socio-emotional interactions, e.g., antagonism (r = 0.14, p < 0.01). Time-workload pressure correlated with reduced task-oriented communication, e.g., gives opinion (r = −0.15, p < 0.01), and positive socio-emotional interactions, e.g., solidarity (r = −0.17, p < 0.001). Time-on-task negatively correlated with task-oriented communication, e.g., asks for orientation (r = −0.16, p < 0.001), and positive socio-emotional interactions, e.g., agrees (r = −0.21, p < 0.001). Team size and disciplinary diversity positively correlated with task-oriented communication, e.g., asks for orientation (r = 0.13, p < 0.001; r = 0.09, p < 0.05), and negative socio-emotional interactions, e.g., antagonism (r = 0.10, p < 0.01; r = 0.08, p < 0.05). Gender balance had no significant relationships (all p > 0.05), however, case reviews with more males present were associated with more tension (r = 0.09, p < 0.01) and less disagreements (r = −0.11, p < 0.01), while when more females present there were more disagreements (r = 0.10, p < 0.01) and less tension (r = −0.11, p < 0.01). Discussion: To the best of our knowledge, this is the first study to assess the relationship between MDT interaction/communication and the external/internal factors. Smaller size, gender balanced teams with core disciplines present, and streamlining workload to reduce time-workload pressure, time-on-task effects, and logistical issues appear more conducive to building and maintain optimal MDTs. Our methodology could be applied to other MDT-driven areas of healthcare.

Background Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case‐complexity affect the quality of MDT decision making. Methods This was a cross‐sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions. Results The full regression model with the variables proposed by the functional perspective was significant, R 2 = 0.52, F(20, 801) = 43.47, P, To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in the context of cancer MDT meetings. Validated observational instruments were used to measure quality of decision making, interactions, and complexity of 822 case discussions across 3 cancer teams and 30 of their weekly meetings. One novel finding is unraveling the sociocognitive predictors of team DM quality, while another is the cognitive‐catch 22 effect

Funder: Health Services and Delivery Research Programme; FundRef: https://doi.org/10.13039/501100002001, Guided by the principles of conversation analysis, we examined the communication practices used to negotiate levels of participation in cancer multidisciplinary team meetings and their implications for patient safety. Three cancer teams participated. Thirty-six weekly meetings were video recorded, encompassing 822 case reviews. A cross-section was transcribed using Jefferson notation. We found a low frequency of gaps between speakers (3%), high frequency of overlaps (24%), and no-gaps-no-overlaps (73%), suggesting fast turn transitions. Securing a turn to speak is challenging due to a systematic reduction in turn-taking opportunities. We contribute to group research with the development of a microlevel methodology for studying multidisciplinary teams.

Background and Objective There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned; however, no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool. Methods We used a mixed‐methods approach involving psychometric evaluation and expert review to develop the Measure of case‐Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in six phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert‐team reviews. Results Phase‐1: case complexity factors identified through literature review and expert interviews; Phase‐2: 51 factors subjected to iterative review and content validation by nine cancer teams across four England Trusts with nine further items identified; Phase 3: 60 items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey; Phases 5 and 6: excellent interassessor reliability between clinical and nonclinical observers, and adequate validity on 903 video case discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC. Conclusions MeDiC is an evidence‐based and expert‐driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization., There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned, however no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool. We used a mixed‐methods approach involving psychometric evaluation and expert review to develop the Measure of case‐Discussion Complexity (MeDiC).

A 73-year-old man with gallstone disease was admitted with right upper quadrant abdominal pain. He was treated for cholecystitis with intravenous antibiotics. Two days later, he reported of new onset left iliac fossa pain, with tenderness and guarding. An abdominal X-ray demonstrated small bowel obstruction, a CT scan demonstrated an impacted gallstone within the proximal ileum. He was treated for a gallstone ileum and underwent an uncomplicated laparotomy, small bowel enterotomy and removal of a faceted gallstone. Three months later, the patient re-presented with generalised abdominal pain, guarding and rebound tenderness. Small bowel obstruction was again demonstrated with an impacted gallstone within the distal ileum seen on CT scan. A second laparotomy revealed two further faceted gallstones, which were removed through an enterotomy. The densely adherent gallbladder to the duodenum precluded a surgical repair of the cholecystoduodenal fistula. He made an uneventful recovery and was subsequently discharged home.