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Multidisciplinary team (MDT) meetings are common to many fields of medicine and widely established internationally. They are intended to ensure higher-quality decision-making and improved patient outcomes. For patients with end-stage kidney disease (ESKD), decisions on whether to place marginally suitable candidates on the kidney transplantation waiting list can be challenging and as such they are supported by MDT meetings. Uncertainty in terms of the best course of action can be linked with a dearth of knowledge or evidence on specific medical conditions and likely implications for successful transplantation, but also on unforeseen outcomes influenced by patient behaviours. In this project, we observed how MDT meetings work in practice in kidney transplant listing, unpacking issues of risk and uncertainty in transplant decision-making processes. Our findings indicate that a central value of MDT meetings is managing medical uncertainty and psychosocial risks, and distributing responsibility for complex transplant listing decisions to ensure equity of access to transplantation as well as an efficient use of scarce kidneys. This sheds light on strategies enacted to mitigate these risks and uncertainties, and the role played by different types of knowledge (experiential versus scientifically evidence-based) in the overall decision-making process. [ABSTRACT FROM AUTHOR]

Abstract: Background: Multidisciplinary team meetings (MDTM) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTM for IBD patients. Methods: Retrospective review of MDTM from March 2013 to July 2016. Each patient’s first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top‐level recommendations were implemented within 6 months. Results: MDTM attendance included an IBD gastroenterologist, surgeons, a radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters of 166 patients were reviewed: 86 females, mean age 40 years, 140 (84.3%) with Crohn disease and mean disease duration of 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients, with hard copies in 84%. In 151 of 166 episodes, all (n = 127) or top‐line (n = 24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow up: 27 months). Amongst patients with unsuccessful MDTM (n = 13), only two (15.4%) were in clinical remission at follow up. Barriers to implementation included patients declining recommendations and loss to follow up. Conclusion: The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring that 100% of reports are available and addressing implementation delays. Patient factors that require addressing include improved engagement and understanding reasons for declining recommendations. [ABSTRACT FROM AUTHOR]

The concept of multidisciplinary team meetings (MDTs) in cancer care is endorsed internationally, but its uptake varies considerably. In Belgium, MDT meetings were financially recognised in 2003 to encourage healthcare professionals to join their knowledge and competences to improve the quality and coordination of cancer care. This study aimed to evaluate for seven cancer types diagnosed between 2004 and 2011, the practices of MDT meetings in Belgium by means of population‐based administrative databases. Results show a clear increase over time in the proportion of individual patients discussed at MDT meetings. Although this evolution may be partly explained by the legal implementation of several financial initiatives to stimulate MDT meetings, it also suggests an increase in specialists’ awareness of the importance of such meetings. Nevertheless, there is still room for improvement, for specific cancer types as well as for certain subgroups such as older patients. From the specialists’ point of view, reducing the administrative burden and time these meetings demand may entail a greater participation to MDT meetings. Further research is needed to identify the barriers to discuss more patients at MDT meetings and to elucidate the impact of MDT meetings on the quality of cancer care. [ABSTRACT FROM AUTHOR]

Objectives: Multidisciplinary team meetings (MTM) are essential in the choice of a therapeutic strategy in head and neck cancer. In many centres patients attend MTMs and are examined by the team. The aim of this study was to assess the influence of the patient's presence on therapeutic decisions. Study design: Prospective study of 119 consecutive patients. Methods: Two therapeutic situations were compared: the therapeutic decision taken following discussion of the patient's file in the MTM (D1) and the therapeutic decision taken after examination of the patient during MTMs (D2). Concordance between the two situations was measured. Results: Concordance between D1 and D2 was 97%. No factors likely to decrease concordance were identified. Decisions taken during MTMs were acted upon for 97% of the patients. Conclusion: The presence of the patient during MTMs is not essential if the files are thoroughly presented and discussed. [ABSTRACT FROM AUTHOR]

Background Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial. Method Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees. Findings A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing. Conclusion Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives To develop a guideline with quality criteria for an optimal structure and functioning of a multidisciplinary team meeting ( MTM), and to assess to what extent the Dutch MTMs complied with these criteria. Method A literature search and expert opinions were used to develop a guideline for optimal MTMs. In order to assess adherence to the guideline, we conducted interviews with MTM chairs and observed general and tumour-specific MTMs in seven hospitals. Results The new guideline included the following domains: (i) organization of the MTMs; (ii) membership of the MTM and roles and responsibilities of the members; (iii) the meeting itself; and (iv) documentation of meeting-recommendations. We observed good adherence to the quality criteria on the organization of the MTMs. Only the required coordinator/administrative support was often absent, particularly during general MTMs. Regarding membership of MTMs and roles, the recommended average attendance of 100% of the core disciplines was never reached and particularly the role of the chair needs improvement. Regarding the meeting itself, many interruptions took place and relevant information about the diagnoses of the cases was not available in 4-5% of the cases. Concerning the documentation of meeting-recommendations, only in a quarter of the meetings a specific form was used for the documentation. Conclusions We found a lot of diversity in the organization of MTMs. The variation in compliance with the quality criteria may decrease with better knowledge about the quality criteria around MTMs and by overcoming practical barriers for the effective organization of MTMs. [ABSTRACT FROM AUTHOR]

Abstract: Australian breast cancer specialists'' involvement in multidisciplinary team (MDT) treatment planning meetings was ascertained in a cross sectional survey. The format of MDT meetings was also investigated. Medical specialists were regular attendees (≥78%) compared to allied health staff and psychologists (≤28%). Clinicians based in a major city (AOR 1.90; 95%CI: 1.01–3.58) and who treated ≥50 new cases a year (AOR 7.34; 95%CI: 3.38–15.96) were more likely to attend. Over 69% reported that the proportion of time devoted to case discussions was ≥75%. Topics always discussed were pathology, extent of disease, surgery performed and a treatment plan (≥83%). The majority of respondents stated that MDT meetings were effective and improved referrals. Suggested improvements included that all key personnel attend, meetings are structured and that the views of all be heard. Work is needed to ensure MDT''s function and co-operate as intended in treatment planning meetings. [Copyright &y& Elsevier]

Background There is no mechanism in place for monitoring or quality improvement of cancer multidisciplinary meetings ( MDM) in Australia. Aim To develop a peer-review process for quality improvement of MDM. Methods This project involved three phases: (i) development of a draft peer-review framework, supporting documents and peer-review process; (ii) consultation with key stakeholders; (iii) refinement of the framework, documents and processes following a pilot study with three MDM. Results Feedback indicated that specific standards included in the framework needed to allow the peer reviewers to be flexible relative to the circumstances of the individual MDM. Conversely, feedback identified the need for clear, evidence-based clinical practice guidelines for the conduct of MDM, with accepted standards and objective measures of performance. MDM members were divided about the need to employ peer reviewers from the tumour stream of the MDM under review but agreed that closer involvement of the team under review to support the implementation of recommendations is warranted. Conclusions We developed an adaptable peer-review framework and process using the current available evidence and guidance. While further research is needed to establish what constitutes best practice in MDM and which processes contribute to improved patient outcomes, the structured peer-review process we describe, when modified using the disease-relevant evidence, could be utilised more broadly as a quality improvement tool. [ABSTRACT FROM AUTHOR]