Zusammenfassung
Die prätherapeutische Diskussion individueller Patientenfälle in einem multidisziplinär besetzten Tumorboard (MDT) hat sich zu einem internationalen Standard entwickelt. Die Notwendigkeit solcher MDT ergibt sich aus der zunehmenden Komplexität der Behandlungsmodalitäten und hat zum Ziel, kosteneffektiv jedem Patienten Zugang zu den modernsten und effektivsten Therapien für seine Erkrankung zu ermöglichen. Die MDT sind mit einem hohen personellen und logistischen Aufwand verbunden. Eine Vielzahl von Studien hat aber gezeigt, dass mit der interdisziplinären Diskussion in MDT in einer Vielzahl der Fälle eine tatsächlich veränderte Therapieempfehlung verbunden ist. Während Aspekte wie effektive Teamstruktur und -leitung, Infrastruktur und Logistik wissenschaftlich untersucht worden sind, liegen kaum wissenschaftliche Daten zum Kommunikationsprozess in MDT und den zugrunde liegenden individuellen Kommunikationskompetenzen der beteiligten Fachvertreter vor. Aus der Kommunikationsforschung ist bekannt, dass heterogen zusammengesetzte Gruppen häufig nicht ausreichend Gebrauch von ihrem nominellen Wissensvorsprung machen. Situative und strukturelle Barrieren beeinträchtigen zusätzlich das Kommunikationsverhalten und damit die Entscheidungsgüte. Unabhängige Moderatoren sowie Regeln für den Kommunikationsprozess, die unter den Beteiligten Konsens sind, helfen diese Defizite abzumildern. Die Professionalisierung und Standardisierung von MDT in Bezug auf Struktur, Prozesse und Kommunikation würde eine Vergleichbarkeit der Entscheidungen ermöglichen und dazu beitragen, die Qualität messbar und entwicklungsfähig zu machen.
Abstract
The pretherapeutic discussion of individual patient cases within a multidisciplinary tumor board (MDT) has become an international standard of cancer care. The necessity of such an MDT derives from the increasing complexity of treatment options and aims to achieve a cost-effective access to the most modern and effective treatment available for every cancer patient. However, MDTs are associated with a high organizational and personal effort but many studies have shown that in many cases an actually altered therapy recommendation is associated with the interdisciplinary discussion in the MDT. While aspects, such as optimum team structure and team leadership, infrastructure and logistics have already been investigated, there are less data on optimum communication processes and the individual communication capabilities of participating physicians. It is well known from communication research that heterogeneous groups do not use their nominal advantage in knowledge appropriately. Contextual as well as structural barriers have a further negative influence on the communication behavior and quality of decisions. Independent moderators and communication rules that have been agreed between MDT participants might help to overcome these limitations. Professionalizing and standardizing MDTs in terms of structure, processes and communication would allow a comparison of individual decisions as well as measurement and improvement of MDT quality.
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Interessenkonflikt. K. Homayounfar, D. Mey, M. Boos, J. Gaedcke und M. Ghadimi geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Homayounfar, K., Mey, D., Boos, M. et al. Kommunikation im Tumorboard. Forum 30, 214–217 (2015). https://doi.org/10.1007/s12312-015-1301-9
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DOI: https://doi.org/10.1007/s12312-015-1301-9