Annals of Surgical Oncology

, Volume 19, Issue 6, pp 1759–1765 | Cite as

Development and Evaluation of a Checklist to Support Decision Making in Cancer Multidisciplinary Team Meetings: MDT-QuIC

  • B. W. Lamb
  • N. Sevdalis
  • C. Vincent
  • J. S. A. Green
Healthcare Policy and Outcomes

Abstract

Background

The quality of decision-making in cancer multidisciplinary team (MDT) meetings is variable, which can result in suboptimal clinical decision making. We developed MDT-QuIC, an evidence-based tool to support clinical decision making by MDTs, which was evaluated by key users.

Methods

Following a literature review, factors important for high-quality clinical decision making were listed and then converted into a preliminary checklist by clinical and safety experts. Attitudes of MDT members toward the tool were evaluated via an online survey, before adjustments were made giving rise to a final version: MDT-QuIC.

Results

The checklist was evaluated by 175 MDT members (surgeons = 38, oncologists = 40, specialist nurses = 62, and MDT coordinators = 35). Attitudes toward the checklist were generally positive (P < 0.001, 1-sample t test), although nurses were more positive than other groups regarding whether the checklist would improve their contribution in MDT meetings (P < 0.001, Mann–Whitney U test). Participants thought that the checklist could be used to prepare cases for MDT meetings, to structure and guide case discussions, or as a record of MDT discussion. Regarding who could use the checklist, 70% thought it should be used by the MDT chair, 54% by the MDT coordinator, and 38% thought all MDT members should use it.

Conclusion

We have developed and validated an evidence-based tool to support the quality of MDT decision making. MDT members were positive about the checklist and felt it may help to structure discussion, improve inclusivity, and patient centeredness. Further research is needed to assess its effect on patient care and outcomes.

References

  1. 1.
    Brennan TA, Leape LL, Laird NM. Incidence of adverse events and negligence in hospitalised patients. N Engl J Med. 1991;324:370–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Calland JF, Guerlain S, Adams RB, Tribble CG, Foley E, Chekan EG. A systems approach to surgical safety. Surg Endosc. 2002;16:1005–14.PubMedCrossRefGoogle Scholar
  3. 3.
    Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239:475–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Committee on Quality of Health Care in America. Institute of Medicine. Washington, DC: National Academy; 2000.Google Scholar
  5. 5.
    Lingard L, Regehr G, Orser B, Reznick R, Baker GR, Doran D, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143:12–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18:71–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Haynes A, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Lamb B, Brown K, Nagpal K, Vincent C, Green JSA, Sevdalis N. Quality of care management decisions by multidisciplinary teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25. doi:10.1245/s10434-011-1675-6.PubMedCrossRefGoogle Scholar
  10. 10.
    Manual for cancer services. London: The Department of Health; 2004.Google Scholar
  11. 11.
    Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary team working in cancer: What is the evidence? BMJ. 2010;340:c951. doi:10.1136/bmj.c951.
  12. 12.
    Newman E, Guest A, Helvie M, Roubidoux MA, Chang AE, Kleer CG, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107:2343–51.CrossRefGoogle Scholar
  13. 13.
    Hong NJ, Wright FC, Gagliardi AR, Paszat LF. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J Surg Oncol. 2010;102:125–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Haward R, Amir Z, Borrill C, Dawson J, Scully J, West M, et al. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer. 2003;89:15–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116:511–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Lamb B, Sevdalis N, Mostafid H, Vincent C, Green JS. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol. 2011;18:3535–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17:457–60.PubMedCrossRefGoogle Scholar
  18. 18.
    Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis. 2008;10:769–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Lamb B, Wong H, Vincent C, Green JSA, Sevdalis N. Teamwork and team performance in urological multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf. 2011;20:849–56. doi:10.1136/bmjqs.2010.048660.PubMedCrossRefGoogle Scholar
  20. 20.
    Lamb B, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making in multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35:1970–6. doi:10.1007/s00268-011-1152-1.PubMedCrossRefGoogle Scholar
  21. 21.
    Hales BM, Pronovost PJ. The checklist—a tool for error management and performance improvement. J Crit Care. 2006;21:231–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Verdaasdonk EG, Stassen LP, Widhiasmara PP, Dankelman J. Requirements for the design and implementation of checklists for surgical processes. Surg Endosc. 2009;23:715–26.PubMedCrossRefGoogle Scholar
  23. 23.
    Hales B, Terblanche M, Fowler R, Sibbald W. Development of medical checklists for improved quality of patient care. Int J Qual Health Care. 2008;20:22–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Winters BD, Gurses AP, Lehmann H, Sexton JB, Rampersad CJ, Pronovost PJ. Clinical review: checklists—translating evidence into practice. Crit Care. 2009;13:210.PubMedCrossRefGoogle Scholar
  25. 25.
    Lanceley A, Savage J, Menon U, Jacobs I. Influences on multidisciplinary team decisionmaking. Int J Gynecol Cancer. 2008;18:215–22.PubMedCrossRefGoogle Scholar
  26. 26.
    Lamb B, Green JSA, Vincent C, Sevdalis N. Decision making in surgical oncology. Surg Oncol. 2010;20:163–8. doi:10.1016/j.suronc.2010.07.007.PubMedCrossRefGoogle Scholar
  27. 27.
    Lamb BW, Allchorne P, Sevdalis N, Vincent C, Green JSA. The role of the cancer nurse specialist in the urology multidisciplinary team meeting. Int J Urol Nurs. 2011;5:59–64. doi:10.1111/j.1749-771X.2011.01119.x.CrossRefGoogle Scholar
  28. 28.
    Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JS. Multidisciplinary team working across different tumour types: analysis of a national survey. Ann Oncol. 2011;19 Oct (Epub ahead of print).Google Scholar
  29. 29.
    Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, et al. Use of electronic health records in U.S. hospitals. N Engl J Med. 2009;360:1628–38.PubMedCrossRefGoogle Scholar
  30. 30.
    NHS Summary Care Record. http://www.somersetpct.nhs.uk/welcome/services/nhs-summary-care-record/. Accessed 27 June 2011.

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • B. W. Lamb
    • 1
    • 2
  • N. Sevdalis
    • 1
  • C. Vincent
    • 1
  • J. S. A. Green
    • 2
  1. 1.Department of Surgery and CancerImperial College LondonLondonUK
  2. 2.Department of UrologyWhipps Cross University HospitalLondonUK

Personalised recommendations