Dr Tayana Soukup has spent a decade studying multi-disciplinary teams. She outlines some recent findings on the workload, cost, quality and safety issues facing MDT meetings – and considers how cognitive aides and collaborative platforms like Vitaly could be used to address them.
Can you tell us about yourself?
I am a chartered psychologist and a research scientist at Imperial College London. I have a PhD in psychology applied to medicine, which was funded by the National Institute for Health and Care Research and which focused exclusively on cancer multi-disciplinary teams.
I’ve published more than 50 papers on MDTs and on the factors that help – and hinder – them when they meet to review patients. My colleagues and I have also trained MDT members and developed evidence-based interventions and tools that can be used in quality improvement initiatives.
Why study MDT meetings?
Initially, I was interested in the behavioural aspect of MDT meetings. They are a unique part of the cancer pathway. You have everybody involved in the care of the patient come together on a regular basis as part of their weekly meeting, so it is a great place to study how doctors and nurses interact and to see how they get things done.
At the same time, it’s important to understand MDT meetings if you want to improve the safety and quality of cancer care. MDT meetings are seen as the gold standard. Before they were set up, treatment decisions could be taken by just one or two clinicians, which led to variation in care.
Patients could get different treatment plans, depending on who they saw. MDT meetings were introduced to reduce that variation – so we need to know whether they are effective for its intended purpose. Plus, the NHS spends a lot of money on this activity – something like £100 million a year – so we need to make sure it is delivering value.
And there is an implementation science aspect – we can think of MDT meetings as a team intervention with a protected time and space for doctors and nurses to come together and plan the care for patients collaboratively.
We know that it takes an average of 17 years for an innovation to become embedded in healthcare. And so we need evidence of what works in terms of improving the processes, and why, and whether it can be refined, and if it can what interventions/innovations will be effective if we are going to reduce that translational gap.
What does the research show?
Government and cancer bodies have developed guidance for which professionals should be at an MDT meeting and for conducting them efficiently. MDT member(s) should put forward information about the case, there should be a discussion, and that should lead to a decision that can be implemented by the responsible clinician.
However, when we go into a meeting, or review videos of meetings, we find there is unequal participation – for example, consultants contribute a lot more than cancer nurses. Also, the information coverage is skewed towards biomedical aspects of the disease.
That can be at the expense of information on patient comorbidities, their psychosocial aspects and views on treatment options. Yet we know that treatment decisions are more likely to be implemented if the MDT meeting considers this type of information – which is information that nurses most often tend to have.
What practical problems do MDT meetings face?
Cancer incidence is on the rise (globally) and there are more and more patients coming forward, so the workload is increasing all the time. The meetings themselves are taking longer and longer. You can be there for five hours, or more in some cases.
Not surprisingly, we have found that the quality of the decision-making declines as the meeting progresses– you don’t want to be the last patient on the list when the list can have 70 patients on it. One intervention that we piloted in the past was a short break – just ten minutes can make a big difference.
Logistical issues are also a problem. Incorrect and missing information adds to the length of meetings. A lot of time can be taken up talking about problems – like the patient’s name being spelled incorrectly or their date of birth being wrong – or looking for information and reports.
Often, the pathology report or the radiology report isn’t there, or there are challenges in retrieving the reports electronically. I was in a meeting in which a doctor had to go back to his office to find a report – and he was gone for 17 minutes. That’s unusual, but at least he found it.
If there is no information, the case may have to be referred to another MDT meeting. That adds to its workload, and it adds to the complexity of the patient pathway, because the patient will have to wait for that to happen. Fortunately, technology can play a big role in preventing this.
How can technology support cancer MDTs?
Technology is an under-explored area when it comes to MDTs, particularly in the UK. Many trusts are still using paper notes for most or all of their cancer MDTs; or they’re using platforms that weren’t designed specifically for MDT meetings.
I think that technology that reduces the cognitive burden, and that makes the process more streamlined, has a significant role to play. For example, a colleague designed a decision aide to make sure that the right people are present at MDT meetings and that the right information is available.
It is on paper – but making it digital could make it much more effective. Platforms like Vitaly can also support MDT meetings by structuring the information that is needed, making sure it is accessible, that all the users are present, and have the chance to contribute, and that decisions are written back to the patient record. Such platforms also have the potential to reduce preparation time for these meetings.
What about other specialties?
There is a lot of research on the role of MDTs in cancer, but much less for other conditions. Mental health holds a lot of MDT meetings, but it hasn’t given the same priority to research into their impact. It’s probably where cancer MDTs were 20-years ago.
When I started researching this area with colleagues, hardly anybody wanted to study MDTs because it is a challenging are to study. Interest has grown with the ambition to make changes and because research is aligned with what NHS England and the cancer alliances want.
That does mean there is an opportunity for mental health and dementia and other chronic conditions to learn from cancer care. Decision aides and technology are needed across the board, and I think that is where the future lies.
Are you optimistic about the impact of technology?
I am very optimistic! Over the past few years, we and other research groups have been able to develop many interventions and aids to reduce the workload and cost associated with MDT meetings and to improve the quality and safety of decision-making. We have check-lists and pro-formas and various assessment tools; but they are paper-based tools.
Now we need to streamline them and make sure technology platforms are in place to support clinicians, so they can instead do their jobs more efficiently and effectively. MDT meetings bring together some of the most experienced and knowledgeable professionals in the NHS.
They don’t want to spend their time sitting in meetings wrestling with logistics. They want to do their jobs and make things better for patients by getting implementable treatment plans together, faster.
Find out more at our June webinar:
Dr Soukup will be taking part in a webinar that Parsek is running on the digitalhealth.net platform on 20 June 2023.
She will be joined by working clinicians from the UK and The Netherlands to discuss “Digitally supported MDT meetings: What to expect and what does success look like?”
The discussion from 12.30-13.30 BST (13:30-14:30 CEST) will be chaired by Digital Health editor Jon Hoeksma, who will be looking to make sure that attendees get hands-on insights into the benefits of using a digital MDT platform like Vitaly and practical tips for success.
Learn more about the event and register here: