Multi-Disciplinary Team Meeting Reforms

Background During 2017, the 12 Chairs of the Cancer Network Groups studied the recommendations from the Cancer Research UK MDT Effectiveness Report, and identified areas where changes could be implemented, including the following: Development of treatment protocols Review of MDT attendance Improvement of incoming information/real time data collection MDT Mortality and Morbidity reviews. In August 2017, Professor Martin Gore was appointed by the National Cancer Transformation Board to reform MDTM working arrangements across the UK

Response The SSG Chairs decided to hold a meeting of the SWAG Cancer Clinical Leads to define a loco-regional approach to MDT reforms prior to meeting with Professor Gore and his team All MDT Leads were invited and representatives from each cancer site attended the meeting

Inaugural meeting of the SWAG Cancer Clinical Leads, Monday 16th July 2018 Guest Speaker: Cognitive Scientist, Tayana Soukup Acencao Improving teamwork can increase meeting quality Teamwork can be assessed and improved using validated tools Training is needed to use the tools Improvements identified can be made via audit and feedback cycles

Inaugural meeting of the SWAG Cancer Clinical Leads, Monday 16th July 2018 Guest Speaker: Cognitive Scientist, Tayana Soukup Acencao Cognitive fatigue after 1 hour/discussion of >20 patients reduces the quality of decision making. The addition of a 10 minute break has been shown to balance the quality of decision making and reduce the length of the overall meeting: SWAG MDT Priority Recommendation

SWAG MDT Priority Recommendations To arrange visits to alternative MDTs to compare different styles Development of online MDT referral proformas (starting with Breast and CRC) to improve quality of information / allow for triage of cases

SWAG MDT additional recommendations Improvement of video conferencing facilities (specifically the network systems) Administrative support for tracking results / a regional digital tracker for use across the region (it was noted that Gloucestershire Hospitals do not have the same system as the other SWAG Trusts) Protected MDT planning time to stratify discussions so that radiology and pathology colleagues can attend a specific slot Training for MDT Coordinators to assist with stratifying the MDT meeting

SWAG MDT additional recommendations Design a process by which the patient pathway can be progressed outside the MDT with decisions documented to ensure an audit trail is fed back to the MDT Provide GP advice and guidance on making appropriate referrals Training to use the MDT assessment tools Specialist radiology and pathology reviews of agreed cases outside the MDT meeting Encourage referring hospitals to start diagnostic processes where appropriate Reconfigure room space.

Next Steps Professor Gore’s team has invited MDTs to join an MDT streamlining pilot to develop predetermined standards of care. SWAG Breast and CRC MDTs are participating in the pilot SWAG Cancer Clinical Leads are to implement recommendations from the meeting. Progress will be discussed at the next meeting, to be held in 6 months’ time.