News

Team meetings do not devote enough time to complex cancer cases, report warns

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j114 (Published 11 January 2017) Cite this as: BMJ 2017;356:j114
  1. Anne Gulland
  1. London

Doctors and other staff members spend an average of just 3.2 minutes discussing each patient during multidisciplinary team meetings, a report by Cancer Research UK has found.1

The report called for an overhaul of the running of multidisciplinary team meetings where cancer patients’ diagnosis, treatment, and care are discussed. It said that they are a drain on staff resources and do not devote enough time to complex cases.

The report says that since the meetings were introduced in 1995 the NHS has changed dramatically, with a huge increase in demand and only minor increases in capacity. In 2014-15 around 1.4 million discussions took place, a figure that has increased by 20% each year since 2011.

Researchers observed 24 team meetings discussing 624 patients, as well as surveying 3550 members of staff. The researchers found that there was not enough time to discuss complex cases, with just 3.2 minutes devoted to each patient on average. More than half of the discussions were less than two minutes, they found.

The report said, “It is difficult to imagine that this method of working produces the same quality of discussion for all patients, or that there is always enough time for full discussion of patients with complex cases.”

The report called for the streamlining of meetings so they can concentrate on complex cases. It said that certain subgroups of patients follow well established protocols and these cases could be discussed outside the meeting. When staff were surveyed, 74% agreed that meetings should be streamlined.

The report also showed how meetings had a significant impact on workloads, with some meetings lasting up to five hours. On average 14 members of staff attended each meeting. In some meetings every attendee spoke but in others only a handful made contributions.

However, because staff could not always attend the meetings no decision was reached for some patients. In England, attendees are required to attend 66% of meetings but this target is often difficult to reach, the report warned, and therefore there are delays in patient care. It recommended changing the guidelines to ensure that each specialty is represented in the meeting, rather than a named member of staff.

Researchers also found that factors not relating to a patient’s tumour were rarely discussed in meetings—just 14% of the discussions observed looked at issues such as co-morbidities or the patient’s preference. The report said that a standardised document should be used that included information such as the patient’s general fitness, diagnostic information, and whether the patient was suitable for clinical trials.

Emma Greenwood, Cancer Research UK’s director of policy, said: “This research shows the need for change to ensure that meetings make the best use of our specialists’ time while making sure that patients continue to get the best treatment.

“The number of healthcare professionals willing to get involved in this work shows how important it is to the staff. It’s really important that the health service in each UK nation takes these recommendations on board to make these meetings more time and cost effective.”

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