Characterizing Different Multidisciplinary Team Models Implemented Within One Comprehensive Cancer Center

Abstract

Sara Alfieri,1,* Cinzia Brunelli,2,* Claudia Borreani,1 Giuseppe Capri,3 Martina Angi,4 Giulia V Bianchi,3 Silvia Lo Dico,2 Pierangelo Spada,5 Viviana Fusetti,2,6 Ernesto Zecca,2 Augusto Caraceni2,7 1Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 2Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 3Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 4General Oncology Surgery 4, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 5Nursing, Technicians and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 6Biomedicine and Prevention Department, University of Rome “Tor Vergata”, Rome, Italy; 7Department of Clinical and Community Sciences, Università degli Studi, Milan, Italy*These authors contributed equally to this workCorrespondence: Cinzia Brunelli, Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy, Tel [phone], Email [email protected]: The multidisciplinary approach is considered “best practice” in oncology. Multidisciplinary Teamwork (MDTW) can be broadly classified into Multidisciplinary Team Meetings (MDTM) and Multidisciplinary Cancer Clinics (MDCC; involving also patients), yet both models are heterogeneously implemented.Purpose: This study aims at describing the different MDTW implemented models in a Comprehensive Cancer Center.Methods: All clinical unit directors of the hospital were contacted to identify any MDTW activities the personnel of the unit were involved in. Structured interviews were carried out to collect MDTWs information, ie, type (MDTM vs MDCC), team composition, aims, disease phase, use of Patient Reported Outcome Measures (PROMs). Descriptive analyses and Social Network Analysis (SNA) were performed.Results: Among 38 structured interviews, 25 concerned MDTMs and 13 in MDCCs. Responders were mainly surgeons (35%) and oncologists (29%), 35% of them were team leaders. Teams were mostly composed of physicians only (64% in MDTMs, 69% in MDCCs). Case managers (8% and 31%), palliative care specialists (12% and 23%) and psychologists (20% and 31%) were involved to a lesser extent, mainly when dealing with advanced disease. MDTWs were mainly aimed at integrating the skills of the different specialists (respectively 72% for MDTMs and 64% for MDCCs) and offering the best overall patient care pathway (64%, 61.5%). MDTWs were directed at patients in both diagnostic (72%, 61.5%) and locally advanced/metastatic (32%, 38.4%) disease. PROMs were seldom used (24%, 23%). SNA shows a similar density in the two MDTWs, but in the MDCCs two nodes remain isolated (pathologists and radiologists).Conclusion: Despite a high number of MDTWs for advanced/metastatic disease, there is limited involvement of palliative care specialists, psychologists, and nurses.Keywords: case conferences, multidisciplinary cancer conferences, multidisciplinary visits, oncology, tumor board, tumor conferences

Keywords

• case conferences
• multidisciplinary cancer conferences
• multidisciplinary visits
• oncology
• tumor board
• tumor conferences.