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BMC Cancer. 2012; 12: 202.
Published online May 29, 2012. doi:  10.1186/1471-2407-12-202
PMCID: PMC3489862
Measuring the quality of MDT working: an observational approach
Cath Taylor,corresponding author1 Louise Atkins,2 Alison Richardson,3 Ruth Tarrant,4 and Amanda-Jane Ramirez5
1Florence Nightingale School of Nursing & Midwifery, King’s College London, SE1 8WA, London, England
2Centre for Outcomes Research and Effectiveness, University College London, WC1E 7HB, London, England
3Faculty of Health Sciences, University of Southampton and Southampton University Hospital Trusts, SO16 6YD, Southampton, England
4Department of Clinical Oncology, Southampton University Hospitals NHS Trust, SO16 6YD, Southampton, England
5Promoting Early Presentation Group, King’s College London, St Thomas’ Hospital, SE1 7EH, London, England
corresponding authorCorresponding author.
Cath Taylor: cath.taylor/at/kcl.ac.uk; Louise Atkins: l.atkins/at/ucl.ac.uk; Alison Richardson: alison.richardson/at/soton.ac.uk; Ruth Tarrant: rjtarrant/at/doctors.org.uk; Amanda-Jane Ramirez: amanda-jane.ramirez/at/kcl.ac.uk
Received October 27, 2011; Accepted May 29, 2012.
Abstract
Background
Cancer multidisciplinary teams (MDTs) are established in many countries but little is known about how well they function. A core activity is regular MDT meetings (MDMs) where treatment recommendations are agreed. A mixed methods descriptive study was conducted to develop and test quality criteria for observational assessment of MDM performance calibrated against consensus from over 2000 MDT members about the “characteristics of an effective MDT”.
Methods
Eighteen of the 86 ‘Characteristics of Effective MDTs’ were considered relevant and feasible to observe. They collated to 15 aspects of MDT working covering four domains: the team (e.g. attendance, chairing, teamworking); infrastructure for meetings (venue, equipment); meeting organisation and logistics; and patient-centred clinical decision-making (patient-centredness, clarity of recommendations). Criteria for rating each characteristic from ‘very poor’ to ‘very good’ were derived from literature review, observing MDMs and expert input. Criteria were applied to 10 bowel cancer MDTs to assess acceptability and measure variation between and within teams. Feasibility and inter-rater reliability was assessed by comparing three observers.
Results
Observational assessment was acceptable to teams and feasible to implement. Total scores from 29 to 50 (out of 58) highlighted wide diversity in quality between teams. Eight teams were rated either ‘very good/good’ or ‘very poor/poor’ for at least three domains demonstrating some internal consistency. ‘Very good’ ratings were most likely for attendance and administrative preparation, and least likely for patient-centredness of decision-making and prioritisation of complex cases. All except two characteristics had intra-class correlations of ≥0.50.
Conclusions
This observational tool (MDT-OARS) may contribute to the assessment of MDT performance. Further testing to confirm validity and reliability is required.
Keywords: Cancer, Multidisciplinary Communication, Interprofessional relations, Observation, Quality Indicators Health Care, Decision-making, Leadership, Health resources
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