gms | German Medical Science

Background: In multidisciplinary team meetings (MDTMs, also called tumor boards) physicians with different specializations and sometimes other health care providers come together to discuss and recommend paths of treatment for a specific patient. MDTMs are considered best practice in cancer care. However, MDTMs have been found to mostly discuss medical information and pay little attention to the patient’s perspective and psychosocial situation. Hence, the current organization of MDTMs has been argued to not support patient-centered care and shared decision-making (SDM).

Aims: This review aimed to identify recommendations for MDTMs to become more patient-centered and enable SDM.

Methods: A narrative review of existing literature recommending strategies to foster interdisciplinary communication and patient-centeredness in MDTMs was conducted. Two researchers with ample experience in SDM research in cancer care, who previously conducted observational studies in MDTMs, reviewed the literature. The two researchers structured the extracted recommendations in order to function as the basis for an implementation strategy to foster SDM in cancer care. Then, the recommendations were discussed with clinical cooperation partners at a comprehensive cancer center in Germany.

Results: We extracted recommendations from 30 publications, which included original research and reviews as well as opinion pieces. This led to 13 recommendations regarding the following areas:

1.

routine pathways and quality management standards (e.g., consistent denomination as MDTM recommendation instead of decision),

2.

participants (e.g., discussion of a case only if at least one MDTM participant has met the patient),

3.

information discussed during MDTMs (e.g., documentation of more than one possible treatment, if uncertainty exists during meeting), and

4.

tasks of the MDTM coordinator/chair (e.g., communication and leadership training for MDTM chairs).

After discussion with clinical cooperation partners, changes in the setting emerged as a fifth area for change (e.g., changing the seating arrangement into a u-shape).

Discussion and implications: Since MDTMs in their current organization do not foster patient-centered care and SDM, recommendations for changes towards more patient-centeredness and SDM in MDTMs were reviewed and consolidated. Those recommendations can be used to inform implementation efforts to foster patient-centered MDTMs and SDM in cancer care.