Pilot study of the development of a theory-based instrument to evaluate the communication process during multidisciplinary team conferences in rheumatology

摘要

Background: Coordinated teams with multidisciplinary team conferences are generally seen as a solution to the management of complex health conditions. However, problems regarding the process of communication during team conferences are reported, such as the absence of a common language or viewpoint and the exchange of irrelevant or repeated information. To determine the outcome of interventions aimed at improving communication during team conferences, a reliable and valid assessment method is needed. Aim: To investigate the feasibility of a theory-based measurement instrument for assessing the process of the communication during multidisciplinary team conferences in rheumatology. Method: An observation instrument was developed based on communication theory. The instrument distinguishes three types of communication: (Ⅰ) grounding activities, (Ⅱ) coordination of non-team activities, and (Ⅲ) coordination of team activities. To assess the process of communication during team conferences in a rheumatology clinic with inpatient and day patient facilities, team conferences were videotaped. To determine the inter-rater reliability, in 20 conferences concerning 10 patients with rheumatoid arthritis admitted to the inpatient unit, the instrument was applied by two investigators independently. Content validity was determined by analysing and comparing the results of initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to the day patient unit (Wilcoxon signed rank test). Results: The inter-rater reliability was excellent with the intra-class correlation coefficients being >0.98 for both types Ⅰ and Ⅲ communications in 10 initial and 10 follow-up conferences (type Ⅱ was not observed). An analysis of an additional 25 initial and 86 follow-up team conferences showed that time spent on grounding (type Ⅰ) made up the greater part of the contents of communication (87% S.D. 14 and 60% S.D. 29 in initial and follow-up conferences, respectively), which is significantly more compared to time spent on co-ordination (p < 0.001 and 0.02 for categories Ⅱ and Ⅲ, respectively). Moreover, significantly less time spent was spent on grounding in follow-up as compared to initial team conferences, whereas the time spent on coordination (type Ⅲ) increased (both p-values <0.001). Conclusion: This theory-based measurement instrument for describing and evaluating the communication process during team conferences proved to be reliable and valid in this pilot study. Its usefulness to detect changes in the communication process, e.g. after implementing systems for re-structuring team conferences mediated by ICT applications, should be further examined.