Assessing and improving the efficacy of cancer multi-disciplinary teams in urology

Abstract

Cancer care driven by a multidisciplinary team (MDT) meeting is mandatory in UK and has become the platform to discuss cancer cases in many countries worldwide. My aim in this research is to assess the functionality and efficacy of the MDT meeting in making and implementing decisions. Specifically, I aim to develop tools to evaluate how MDTs make clinical decisions and recommendations, understand the role of leadership within these teams and measure why MDT decisions may not get implemented in patient care. The introduction chapter presents an exploration of the evidence base available in the literature on the functionality of cancer MDTs with a focus on how to assess the efficacy of MDTs. In this chapter, I used an ‘input-process-outcome’ framework as a systems approach to the MDT and its working. Chapter 2 is a systematic review of the existing evidence on MDT decision making and decision implementation across surgical specialties. Chapter 3 focuses on urological cancers and retrospectively evaluates MDT decision making from the perspective of implementation of team decisions into patient care. Chapters 4 and 5 present the views of core MDT members on the efficacy of the MDT in addition to problems and shortcomings faced by the MDT and also suggestions for improvement. Chapter 6 presents analysis of a survey on how to improve the efficiency of MDT. Chapters 7 and 8 present data from studies that objectively assess MDT performance by developing and validating observational assessment tools. Finally, the discussion chapter reflects on the findings of this research and discusses their implications for future research and practice.