Elsevier

The Lancet Oncology

Volume 7, Issue 11, November 2006, Pages 935-943
The Lancet Oncology

Review
Multidisciplinary teams in cancer care: are they effective in the UK?

https://doi.org/10.1016/S1470-2045(06)70940-8Get rights and content

Summary

Cancer care can be complex, and given the wide range and numbers of health-care professionals involved, an enormous potential for poor coordination and miscommunication exists. Multidisciplinary teams (MDTs) should improve coordination, communication, and decision making between health-care team members and patients, and hopefully produce more positive outcomes. This review describes the many practical barriers to the successful implementation of MDT working, and shows that despite an increase in the delivery of cancer services via this method, research showing the effectiveness of MDT working is scarce.

Introduction

The continual and rapidly expanding range of potentially efficacious treatment options introduces therapeutic dilemmas about optimum management plans and how these should be presented to patients. Coordination, communication, and decision making between health-care team members and patients are aspects of cancer care that could be improved by multidisciplinary team (MDT) working. However, many practical barriers to the successful implementation of this care method—eg, professional and institutional resistance, and manpower and logistical difficulties1—need to be overcome. Despite an increase in the delivery of cancer services via MDTs, research that shows the effectiveness of MDT working is scarce.2, 3, 4

The UK Department of Health defines a MDT as a “group of people of different health-care disciplines, which meets together at a given time (whether physically in one place, or by video or tele-conferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient” (figure).5 MDTs deal specifically with one type of cancer or group of cancers, and bring together the relevant health-care professionals with specialised knowledge of diagnosis and treatment. The team composition will vary depending on the cancer type and can include surgeons, diagnostic and therapeutic radiologists, histopathologists, medical and clinical oncologists, nurse specialists, and palliative-care physicians. The organisation of multidisciplinary team meetings (MDMs) is left to local discretion; some MDTs review patients from more than one hospital, and some individual team members, especially histopathologists and clinical oncologists, might attend many MDMs in several different locations and for different tumour groups. A team might also liaise closely with other professionals actively involved in the support of the patient—eg, general practitioners, other members of the primary-care team, and palliative-care specialists.

Section snippets

Evolution of MDTs

In the UK, MDT working has been endorsed as the principle way of managing cancer care. The impetus for their widespread introduction began with the 1995 Calman-Hine report6 on the structure and organisation of cancer services in England and Wales. The origins of some of the problems that precipitated this report are summarised in panel 1 and have been discussed elsewhere.7

The Calman-Hine report recommended major organisational changes, including more team working among those providing treatment

Benefits of MDT working

Theoretically, MDT working should ensure effective coordination, and the best quality and good continuity of patient care by bringing together key professionals with all the necessary knowledge, skills, and experience. MDT working would thereby ensure high-quality diagnosis, evidence-based decision making, optimum treatment planning, and delivery of care (panel 2).

The multiprofessional composition of teams should increase the likelihood that individual patients are offered the most appropriate

Requirements for effective MDT working

A number of key requirements need to be met for MDTs to function effectively: good leadership; positive team dynamics; adequate administrative support; good-quality, complete information; sufficient staff time; and funding.

Evidence of MDT effectiveness

Evidence from published empirical studies and reports in the UK on the benefits of MDT working is sparse. Improvements in outcomes due specifically to the introduction of MDT working are difficult to substantiate because of the multiple concurrent changes in cancer care in the past decade; for example, advances in diagnosis and treatment, increased specialisation, improved facilities, the introduction of evidence-based guidelines and protocols of care, changes in referral policies, and raised

Barriers to good practice and functioning

Although MDTs are increasing, the coverage, quality of care, numbers and types of cases selected, and attendance by key staff vary.11 A report examining MDT care in one cancer network in each of eight English regions, plus one in Wales, described many of the problems that arise in practice.75 Not all teams met on a weekly basis, some specialists—eg, pathologists and radiologists—worked with several different types of cancer, making their time commitment especially difficult. This problem was

Conclusions

MDT working has been widely introduced around the UK for the provision of cancer care, but there is little evidence for its direct effect on the quality of patient care. The systems that assess the effectiveness of teams are not fully developed, and better methods to monitor performance, team working, and outcome are needed.34, 59 The paucity of research is partly due to difficulty in the measurement of benefits specifically attributable to MDT working in isolation from other factors.

Search strategy and selection criteria

Data were identified by searches of PubMed, OVID, and references from relevant articles with the search terms and combinations of “multidisciplinary”, “multi-disciplinary”, “team”, “meeting”, “MDT”, “MDM” and “cancer”. Only papers published in English between 1985 and 2006 were included. Documents produced by organisations were also searched through the UK Department of Health and other key UK government agency websites.

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