Role of Modern Technologies in Communication and Decision Making in Surgery

The Department of Surgery in The Mater has an active research programme examining the role of multidisciplinary meetings and information technology in aiding clinical decision making.

Multidisciplinary teams (MDT) have revolutionised decision making in cancer treatment planning over the past half century.  Annually in Ireland, 28000 people receive a new diagnosis of invasive cancer. By 2040 this figure is expected to double. MDTs are now implemented as standard practice in cancer care centres throughout the world and form an integral part of a patient’s cancer workup (Fig. A) However, convincing research into their efficacy is limited. It is suggested that new research should be directed towards investigating ‘better methods to support’ the MDT. The use of computer based systems show considerable promise for‘supporting clinical, operational and governance aspects of the cancer MDTs with reliability, transparency and accountability’.

Simple schema outlining importance of the MDT in cancer care

Multidisciplinary teams are defined as a ‘group of people of different healthcare disciplines which meets together at a given time to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions for that patient’. Although hard evidence on the efficacy and efficiency of MDTs is scarce it has become the standard of care in Western medicine. It is estimated that management of patients by an MDT grew from 20% to 80% between 1994 and 2004 in the UK (2), which may be attributed to the strong recommendations for cancer care reform made in the Calman-Hine report in 1995.

Cancer, as a complex disease process, requires a co-ordinated and multifaceted approach to diagnosis and treatment, which is best achieved by encompassing all modalities of health care. The concept of a multidisciplinary team in cancer care is mostly accredited to the Kaplan and Rosenberg duo in the 1960s with their work on Hodgkin’s lymphoma. Since its introduction into oncology over 50 years ago, the MDT as evolved from a mainly academic and educational forum for discussion to a more patient-centred role in the collaborative diagnosis, staging and management decisions of individual patients. The consultant-led team is comprised chiefly of surgeons, oncologists, radiologists, pathologists and nurse coordinators.

The goal of the MDT is optimal patient care, with quick and definitive diagnosis, using evidence-based practice and ensuring continuity of care for all patients. Secondary to this, the MDT meeting s provide an excellent opportunity for communication and education between the specialties and among junior doctors, as well as identification and integration of suitable patients into clinical trials.

In Ireland

Over the last number of years there have been significant changes to the delivery of health services in Ireland. The major legacy of the Cancer Services in Ireland: A National Strategy report (1996) was the provision of a framework for cancer services; in addition to the allocation of funding to rise to the standard of our European counterparts. A second strategy for cancer control was published in 2006, building on the foundations set by its predecessor and introducing a total reform of the delivery of cancer services in Ireland. Four cancer control networks now exist, each serving a population base of one million and each managing two designated cancer centres – eight in total across the country. These centres, located in the major teaching hospitals are staffed and equipped to manage all the major cancers independently. This report also instructs the diagnosis and treatment of all cancer patients by site-specific multidisciplinary teams, and the inclusion of palliative, psycho-oncology and supportive care for a holistic, patient-centred approach. The pooling of resources, expertise and technology into the designated centres results in more specialised treatment, a higher caseload of patients and greater subspecialisation - all factors which contribute to a greater survival rate.

To conclude, several studies call for more research into the functionality and efficiency of multidisciplinary teams. The necessity for leadership and communication are paramount to the successful running of an MDT but equally, opportunity for all members of the team to contribute to the discussion results in better outcomes for patients. Audit of success and failures within the MDT should be carried out as a constant source of feedback – this will inform further decisions in the future, reduce ineffective or suboptimal care planning and contribute to the ultimate goal of evidence-based treatment and care.

Research Questions

  1. What characteristics make for an effective MDT?
  2. Can a software platform/tool improve the efficacy of the MDT?
  3. Do electronic referral pathways improve MDT decision making?
  4. To audit the level of compliance with MDT decisions
  5. To estimate the level of adherence to current evidence of MDT decisions