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Do multidisciplinary cancer care teams suffer decision-making fatigue: an observational, longitudinal team improvement study
- Source :
- BMJ Open
- Publication Year :
- 2019
-
Abstract
- ObjectiveThe objective of this study was to examine effectiveness of codesigned quality-improving interventions with a multidisciplinary team (MDT) with high workload and prolonged meetings to ascertain: (1) presence and impact of decision-making (DM) fatigue on team performance in the weekly MDT meeting and (2) impact of a short meeting break as a countermeasure of DM fatigue.Design and interventionsThis is a longitudinal multiphase study with a codesigned intervention bundle assessed within team audit and feedback cycles. The interventions comprised short meeting breaks, as well as change of room layout and appointing a meeting chair.Setting and participantsA breast cancer MDT with 15 members was recruited between 2013 and 2015 from a teaching hospital of the London (UK) metropolitan area.MeasuresA validated observational tool (Metric for the Observation of Decision-making) was used by trained raters to assess quality of DM during 1335 patient reviews. The tool scores quality of information and team contributions to reviews by individual disciplines (Likert-based scores), which represent our two primary outcome measures.ResultsData were analysed using multivariate analysis of variance. DM fatigue was present in the MDT meetings: quality of information (M=16.36 to M=15.10) and contribution scores (M=27.67 to M=21.52) declined from first to second half of meetings at baseline. Of the improvement bundle, we found breaks reduced the effect of fatigue: following introduction of breaks (but not other interventions) information quality remained stable between first and second half of meetings (M=16.00 to M=15.94), and contributions to team DM improved overall (M=17.66 to M=19.85).ConclusionQuality of cancer team DM is affected by fatigue due to sequential case review over often prolonged periods of time. This detrimental effect can be reversed by introducing a break in the middle of the meeting. The study offers a methodology based on ‘team audit and feedback’ principle for codesigning interventions to improve teamwork in cancer care.
- Subjects :
- medicine.medical_specialty
media_common.quotation_subject
education
Clinical Decision-Making
Psychological intervention
Breast Neoplasms
Workload
Likert scale
03 medical and health sciences
0302 clinical medicine
Multivariate analysis of variance
Multidisciplinary approach
London
Medicine
Humans
030212 general & internal medicine
Longitudinal Studies
Fatigue
media_common
Patient Care Team
Teamwork
business.industry
Research
Information quality
Disease Management
cancer multidisciplinary team meetings
General Medicine
decision-making
Quality Improvement
Oncology
decision-making fatigue
030220 oncology & carcinogenesis
Physical therapy
Observational study
business
Subjects
Details
- ISSN :
- 20446055
- Volume :
- 9
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- BMJ open
- Accession number :
- edsair.doi.dedup.....adea2566a71c44101bfdf5ee57393d9b