The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs.
Audit study and a questionnaire survey.
Breast multidisciplinary unit in a large secondary care teaching hospital.
All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey.
The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials.
MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered.
Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient outcomes. The decision support technology used in MATE is generic and if found useful can be applied across medicine.
How to improve the conduct of a cancer MDT and standardise decision making in accordance with best evidence.
Development and implementation of a novel clinical decision support (CDS) platform for breast cancer MDT.
This study evaluates (1) the concordance between the CDS suggestions and MDT recommendations and (2) the identification rate of potentially eligible patients for recruiting into the ongoing research trials, by the MDT and the CDS. A separate questionnaire survey was conducted at the national workshop at the Cancer Networks' Development Programme to get an estimate of acceptability of such MDT decision support systems by the cancer networks.
An advanced CDS platform could significantly improve the conduct of cancer MDMs.
Further robust evaluations are necessary.
Strengths and limitations of this study
We share our experience of developing an advanced decision support system and implementing it in a complex clinical environment of cancer MDT, which was subsequently adopted as a breast MDMs management tool.
The results reported here, however encouraging, are at this point indicative of the potential benefits but not yet conclusive. They should be treated with caution until further rigorous evaluations confirm the effectiveness and generalisability of the CDS system.