Urology MDTs: what members think
Reviewed by Ann Crump

This study aimed to examine the functionality of urology cancer multidisciplinary team meetings (MDTs). Evidence has suggested that urology MDTs are not as well structured as other surgical disciplines. MDT members were asked their views on if there were any barriers preventing optimal functioning of the MDT and any suggestions on how things could be improved. Twenty urology MDT members (seven urologists, three radiologists, three pathologists, three medical oncologists and four urology clinical nurse specialists) contributed from seven hospitals. A prospective, qualitative semi-structured interview was used to collect data and transcripts were analysed using emergent theme analysis. Data was then able to be tabulated. Of the 20 participants only 13 had MDT attendance in their job plan. None of the three pathologists had attendance in their job description. Nine participants stated that their MDT attendance clashed with other clinic commitments e.g. ward-based emergencies. The urologists and the nurses attended one MDT per week whereas the pathologists, radiologists and oncologists attended more than one MDT a week. All participants had someone to cover when absent but it was felt that the people present at the MDT can have an effect on the outcome. It was found that there were multiple routes of booking cases on to the MDT e.g. urology team member, radiology cancer alerts. This was felt to lead to confusion with patients not always being known to team members. Also radiologists and pathologists will prepare for the MDT before the meeting with the urologist often looking through the notes at the meeting itself, meaning that the meeting isn’t as efficient as it could be and important details may be missed. It was also felt that not all patients were appropriate for MDT discussion e.g. patients not yet seen, benign cases. Factors such as team member’s absence and lack of case presentation, as well as IT failures inadvertently affected the quality of information exchanged during the MDT. The majority of team members felt that the MDT normally came to a consensus of opinion. Suggested improvements included adequate case preparation, posing a specific question, arranging appropriate cover for member’s absences and ensuring all relevant investigations have been completed prior to discussion. Participants also came up with possible solutions e.g. one consultant suggested a ‘buddy’ system where the ‘buddy’ will prepare the cases etc. when the core member is absent. In order to prepare for the meeting better a degree of protected preparation time was suggested to help provide a better quality discussion. There also needs to be an agreed method of referral to ensure all cases on an MDT come through the same route to ensure all information is available. A standardised pro-forma could help with this. One of the limitations of the study is that it was conducted in one region and other regions may differ in their MDT practice. There is also a subjective bias by the very nature of qualitative research. What is useful is that it demonstrates areas which are potentially open to improvement to make this resource rich MDT meeting more efficient and provide the best possible outcomes for patients.

Case review in urology multidisciplinary team meetings: what members think of its functioning.
Sarkar S, Arora S, Lamb BW, et al.
JOURNAL OF CLINICAL UROLOGY
2014;7(6):394-402.