1. Multi-Disciplinary Team Meeting Reforms

2. 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, and circulated initial information to commence a consultation which incorporated the CRUK recommendations

3. 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 (on another occasion) with Professor Gore and his team
All MDT Leads were invited and representatives from each cancer site attended the meeting

4. 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 measured and improved using validated tools
Training is needed to use the tools
Improvements identified can be made via audit and feedback cycles
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 Recommendation

5. 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

6. 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
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.

7. 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.