"The highest decision-making level" - Multidisciplinary team meetings as boundary spaces

Area of Science:

• Healthcare Management
• Medical Sociology
• Clinical Decision-Making

Background:

• Multidisciplinary team meetings (MDMs), or tumor boards, are integral to collaborative decision-making in Western healthcare.
• Their role in optimizing cancer care pathways and ensuring consistent treatment protocols is widely acknowledged.
• Understanding the dynamics within these critical healthcare forums is essential for improving patient outcomes.

Purpose of the Study:

• To explore the significance and operational dynamics of MDMs in Danish cancer care.
• To analyze the collaborative boundary work performed by professionals within MDMs.
• To investigate how MDM practices influence professional identities, power dynamics, and decision-making processes.

Main Methods:

• An ethnographic approach was employed, involving fieldwork at five Danish university hospitals.
• Data collection focused on observing and analyzing clinician interactions and decision-making processes during MDMs.
• A typology of boundary work (calibrating, reflecting, guarding) was developed to understand professional engagement.

Main Results:

• Clinicians perceive MDMs as key to efficiency, reflexivity, consistency, transparency, and security in patient care.
• MDMs function as boundary spaces where professionals perform collaborative boundary work, enhancing relational agency.
• Practices within MDMs can establish 'gate mechanisms,' privileging specific knowledge and expertise, thereby reconfiguring power dynamics and shaping care regimes.

Conclusions:

• MDMs are recognized as the highest decision-making level in cancer care, fostering collaboration and enhancing agency.
• The boundary work within MDMs, while beneficial, can inadvertently create exclusive spaces that influence professional identities and power structures.
• These dynamics collectively shape the treatment and care regime, highlighting the need for awareness of inclusivity and potential biases in collaborative decision-making.