Multidisciplinary team meetings in cancer care: is there a psychologist in the house?

摘要

Introduction: Multidisciplinary team meetings (MDTMs) are considered best practice in the management and decision-making for cancer patients. The team typically consists of surgeons, medical oncologists, organ specialists, radiologists, pathologists and in some cases oncology specialist nurses and psychologists. They aim at evidence-based, collaborative and multidisciplinary decision-making for cancer treatment and patient management. In Belgium, the multidisciplinary approach is mandatory and formally regulated since 2003. When the Belgian Cancer Plan was launched in 2008 a specific professional group was included in this policy plan: the onco-psychologists. Preliminary study results in Flanders show that onco-psychologists do not systematically attend the MDTMs, while the results also reveal that, in addition to the oncology specialist nurses, they may facilitate the uptake of psychosocial information. To ensure that MDTMs can benefit from their diverse membership to achieve their full potential, significant attention should be devoted to the attendance and active participation of the non-medical disciplines during these meetings. The aim of this study is to explore and describe 1) the multidisciplinary character of MDTMs and 2) the (possible) role of the onco-psychologists to enhance the uptake of psychosocial information during the MDTMs. Methods: This contribution presents an observational study. 59 MDTMs are observed at inpatient medical oncology departments in five different Belgian hospitals (academic as well as general). Results: The findings align with previous studies arguing that MDTMs in oncology are typically driven by doctors, with limited input of onco-psychologists and other nonmedical staff and that decisions are based on biomedical information with far less consideration of psychosocial information. Discussion : A MDTM should not merely be a group of care professionals who work essentially independently and occasionally liase with one another. From these findings we argue that onco-psychologists can potentially bridge the gap between medical and non-medical members of the team becoming an “additional mechanism” to enhance the uptake of psychosocial aspects in treatment decisions. Lessons Learned : This study shows a worryingly low awareness of the true character of multidisciplinarity, particularly among medical disciplines in oncology care. Efforts should be made to change the working culture towards a truly integrated care approach among professionals in oncology. Limitations : The purposive sampling of inpatient medical oncology departments within two academic hospitals and three non-academic hospitals in one country, limits the generalizability of the results for broader organizational contexts and health systems. Suggestions for future research : More empirical studies are needed to reveal the reasons why MDTMs fail to fully integrate all disciplines. Also, more empirical evidence to understand how team composition, hospital culture and organizational or environmental factors can either directly affect MDTM performance or serve as key mediators to its success is needed. Lastly, interventions aiming to support the role of the onco-psychologists are crucial to enhance the input of psychosocial information.