CRUK working group MDT effectiveness proposal Mark Beresford

MDT meetings are primarily clinical business meetings but it is important to ensure that the additional benefits of MDT working are not lost with any proposed changes. Team working and interaction between multi-professional staff Improving operational efficiency of the team by operational review, audit and service evaluation Education and learning opportunities particularly for junior staff Enhanced accrual in to clinical trials

MDT meetings utilise a significant amount of limited clinical staff time and financial resource It is imperative that they are effective A number of ways to improve MDT meetings have been identified and are presented as 10 recommendations

RECOMMENDATION 1 MDT Proformas should be standardised across regions and include patient preferences, patient understanding and relevant social issues that may influence treatment options

RECOMMENDATION 2 Completion of an MDT Proforma must be mandatory The MDT outcome proforma should initiate and facilitate the referral to the treating clinician and therefore needs to include all relevant clinical details

RECOMENDATION 3 Real time electronic completion of the MDT outcome must take place during MDT meetings The chairperson should nominate a clinician to check the accuracy of the real time completion of MDT discussion outcome

RECOMMENDATION 4 For an MDT to function effectively, appropriate infrastructure is required and a meeting room style which encourages participation from all members is essential For MDT meetings that require members from other clinical sites to participate, video conferencing facilities are mandatory

RECOMMENDATION 5 Good chairmanship is essential to effectively manage the meeting and ensure appropriate contribution to relevant cases from all members The role of the Chair should be recognised as a leadership role and therefore should not rotate automatically There should be a clear agenda and structure for the meeting and the reason for discussion of individual patients should be clear Adequate training and support should be given to all MDT Chairs; this could be organised on a regional basis to improve consistency The role also needs to be reflected in their job plan. Chairs are expected to attend 66% of MDT meetings

RECOMMENDATION 6 Full core membership may no longer be appropriate; quoracy should be the measurement for attendance and is mandatory to ensure the quality of discussion at the MDT meeting and informed recommendations It is recognised that all clinicians involved in treating cancer patients should continue to be active members of an MDT and therefore an alternative minimum attendance is required 25% should be the minimum attendance Local arrangements may be required and this target should be seen as a minimum Where appropriate surgeons may need to attend a greater percentage of MDMs to discuss cases they will operate on

RECOMMENDATION 7 The MDT is responsible for making care and treatment recommendations based on the information available and consideration by the relevant 4 disciplines The accountability and responsibility for treatment decisions lies with the clinician and patient, taking into account the recommendations of the MDT

RECOMMENDATION 8 Treatment decisions compared to MDT recommendations should be the focus of annual audits for every MDT

RECOMMENDATION 9 Each MDT needs a mortality and morbidity process to ensure all adverse outcomes come back to the whole MDT rather than just being discussed in surgical or oncological silos

RECOMMENDATION 10 The MDT and MDT meeting should actively manage patient pathways to ensure patients receive treatment in an appropriate time and avoid breaches For some MDT meetings, a pre–meet may be useful to streamline the MDT meeting, however effective proforma completion would negate the need for a pre-meet