Quality of Decision-making at Oncology Multidisciplinary Team Meetings: A Structured Observational Study

Multidisciplinary meetings (MDMs) are crucial in cancer care, with increasing attention on improving the quality of decision-making. Validated tools have been utilised to assess MDM performance internationally. However, no studies have been performed within the Australian context. This study evaluates the quality of decision-making at oncology MDMs across three affiliated academic institutions in Australia.

This prospective observational study encompassed 14 different MDMs across three cancer centres in South Western Sydney Local Health District, NSW, Australia. Two trained observers observed four randomly chosen MDMs per tumour site, assessing the information quality and the team contributions, using the validated Metric for the Observation of Decision-Making (MDT-MODe) tool. Behaviours were scored on a Likert scale from 1 (behaviour contrary to the defined optimum) to 5 (evidence-based optimal behaviour).

A total of 64 MDMs (N = 498 patients) were observed, with an average of seven cases per meeting (range: 2-15). Management decisions were made in 99% of the cases. Psychosocial factors (Mean (M) = 1.27, standard deviation [SD] = 0.70), comorbidities (M = 1.69, SD = 1.13) and patient's views (M = 1.12, SD = 0.51) were less comprehensively addressed compared to radiology (M = 4.10, SD = 1.52), pathology (M = 3.73, SD = 1.54) and patient history (M = 4.60, SD = 0.73) (P <  0.05). Regarding disciplinary contributions, cancer specialist nurses scored considerably lower (M = 1.04, SD = 0.38) compared to other team members (P <  0.05). The quality of information was consistent across MDMs, with mean scores of 2.5 to 2.99, however quality of team contributions varied more significantly.

Evaluating MDMs using a validated tool provides valuable insights into decision-making quality across MDMs. There was a consistent high standard of comprehensive medical information presented, but team contributions varied and psychosocial issues, comorbidities and patient preferences were less well considered. These findings provide an opportunity for offering feedback to MDMs, facilitating the identification of potential interventions to improve the quality of decision-making.