Setting-up a new meeting
When establishing regular MDC meetings for a new team, it is important to gain consensus from all team members on:
- the team responsibilities
- meeting aims and frequencies
- local protocols for issues such as decision making, documentation processes, providing feedback about meeting outcomes, confidentiality and consent.
The planning phase may involve several meetings between team members and should be facilitated by a respected peer. Emphasise on the benefits of the multidisciplinary process will encourage participation. If possible, hold initial planning meetings at a time that is likely to be used for future treatment planning meetings to promote familiarity of timing amongst the team.
Planning meetings can be used to assess current strengths and achievements of the hospital/department as well as to identify areas for improvement or development. If a number of areas for development are identified, it may be necessary to prioritise these, with the aim of working on only one or two at one time.
Team leadership and coordination
Team leadership is a key aspect contributing to successful and sustainable MDC meetings. Leadership and coordination may take a number of forms:
- a ‘champion’ who drives initiatives and is integral in gaining and maintaining support for the meetings; this role is particularly important during the early stages of a team’s formation
- a meeting chair who facilitates discussions during team meetings
- a meeting coordinator who coordinates the logistics for meetings.
These roles require energy, enthusiasm, and an ability to communicate with, and gain input from, other team members. Each role may be undertaken by one or more individuals or multiple roles may be fulfilled by one individual.
Once the roles are allocated it is important that role definition is agreed upon at the outset and that other team members are aware of which team member is responsible for which aspects of meeting organisation and coordination. It is also important to have agreed team members to act as ‘back-up’ for these roles if the primary contact is not available.
(the champion) has strong links with all people in the team… she’s one of these enthusiastic people that every team needs…
The meeting coordinator role is to:
- organise meetings
- identify patients for discussion during the meetings
- collate information and ensures availability of relevant information sources for presentation at meetings
- record outcomes of case conference discussions
- inform the treating clinician and/or the patient’s general practitioner of the meeting outcomes
The role of the meeting coordinator can be undertaken by an administrative personnel, an oncology nurse, data manager, or registrar. At larger centres, registrars may take responsibility for coordinating meetings on an alternating basis. Regardless of who fulfils this role it is important that all team members are aware of who is undertaking the role and that a back-up is available in situations where the primary coordinator is unavailable.
Timing of meetings
Meetings should be held at the same time and place to maintain routine, avoid confusion and facilitate sustainability of MDC. The duration of MDC meetings will be determined by the size of the institution and the number of cases requiring discussion. In general it will be appropriate to limit the meetings to 45–90 minutes. Any time not used for treatment planning may be used for educational purposes or discussion of other relevant issues. Meetings should be held at a time convenient for all attendees and planned to take account of attendance by off-site personnel.
Venue and resources
Generally, hospital meeting rooms can be used as venues for MDC meetings. Venues should have:
- sufficient space for all participants
- access to power points for use of projectors and light boxes
- a ‘round table’ format.
When setting up new meetings, consider sharing equipment with other departments or groups to minimise costs. Provision of refreshments at meetings can be important, particularly if meetings are held outside normal working hours, during breakfast or lunchtimes or towards the end of the working day.
Communication links with the patient’s GP and the MDC team are crucial and should be maintained throughout the cancer journey. The GP of patients due to be discussed at an MDC meeting should be informed of the meeting and encouraged to attend in person or via teleconference. If the GP is unable to attend, a member of the team should communicate treatment decisions to the GP in a timely manner.
Involving off-site attendees
It will not always be possible for all team members to be present at one site. In regional sites, it may be appropriate to plan meetings at times when a visiting specialist is due to be present. For other sites, issues of distance may be overcome using teleconferencing or videoconferencing.
Considerations when involving off-site attendees include:
- ensure off-site attendees have access to the same information as on-site attendees including access to slides, scans and other information that will be presented at the meeting
- encourage off-site attendees to contribute to discussions
- all team members are aware of teleconference and videoconference protocols.
“We built a lot of trust across the private-public interface – before it was a barrier, and now it is an interface…”
Deciding which patients to discuss
All patients with a newly diagnosed cancer should be discussed by the multidisciplinary team. The level of discussion may vary depending on both clinical and psychosocial factors. Some cases may only require brief discussion while others will require more detailed review and comment. There may also be a need to review existing treatment plans for patients who have been discussed previously. Local protocols to guide the decision-making process should be agreed by the team.
Good preparation of materials and information in advance of multidisciplinary meetings is essential. The types of materials and information required at a meeting will vary according to tumour type but are likely to include:
- all relevant medical history details
- pathology reports and slides
- imaging films and scans
- results of diagnostic examinations
- blood test results
- previous treatment plans, if relevant.
The patient’s medical history and diagnostic results can take the form of a ‘patient summary’ prepared prior to the meeting and disseminated to all team members. This task may be assigned to one of many team members, including registrars. Information about the patient’s concerns, preferences and social circumstances should also be presented at the meeting, for example by the oncology nurse (or care coordinator if available) or by the treating physician. It is also appropriate to have access to relevant clinical practice guidelines and other evidence-based information at the meetings.
Collection of relevant information in advance and presentation of results is a task that can be designated, for example, to one or more surgical registrars who regularly attend the meetings. Alternatively, individual clinicians can take responsibility for bringing relevant information to the meetings regarding their own patients. Whichever system is chosen, it is important that the team agrees upon the designated responsibilities from the outset and that back-up plans are in place in case of non-attendance.
"We’ve seen a transition from the presentation of ‘a case of breast cancer’ with a lot of technical detail, to the presentation of ‘a woman with breast cancer’, with background details about who this woman is, what’s going on in her life, what her desires might be, and how that might impact on decision-making …"
After the meeting
It is important that systems are in place to promptly inform team members who were not able to attend the meeting about outcomes, such as the patient’s general practitioner or referring clinician.
Follow-up with the general practitioner should be via letter and may also include a telephone call or a follow-up meeting with the general practitioner. It is also vital to ensure that responsibility is allocated to a specific individual to ensure that the outcomes of the meeting are conveyed to the patient's GP.