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Using a Multidisciplinary Program
Of Cancer Care as a Vehicle for Research Translation
Tracy Robinson (PhD; BA Hons; RN)
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OUR TEAM
• Professor Paul Harnett - Director, Sydney West TCRC
• Ms Pamela Provan - Manager, Sydney West, TCRC
• Assoc Prof Tim Shaw - Director, WEDG, USyd
• Dr Tracy Robinson – Research Fellow (USyd & SW TCRC)
• Kylie Museth (Innovations Manager, SW TCRC)
• Ms Anna Janssen -Project Manager, (Usyd & SW TCRC)
• Dr. Karin Lyons - Research Support Officer (WM)
• Dr Jenny Shannon – Nepean Hospital
• Dr Peter Flynn – Nepean Hospital
• Dr Julie Howle – Westmead Hospital
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Our Place
Sydney West Cancer NetworkComprehensive cancer services network treating
~4000 new cancer patients, over 130000
outpatients and 6000 inpatients annually.
Westmead Millennium InstituteIndependent research institute with over 420
research staff attracting over $20 million in
research grant funding annually.
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Sydney West
• MDT’s are primary vehicle for delivering cancer care in Sydney West
• MDT meetings only one aspect of wider program in cancer care (clinical networks, registrar training etc.)
• Significant investment of time and resources
• Important to define their composition, processes (such as how they document and make decisions)
• Supported by establishment of the Sydney West TCRC
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MDTs as Vehicles for Translational Research
• implementation science complex - involves identifying type of knowledge, perceived relevance, clinicians & the health care setting (Ebener et al., 2006).
• What is the role of MDTs in implementation science and translational research?
• variability in the performance of MDTs
• What is the type and extent of variation that is acceptable or even desirable in MDTs? (Lamb et al., 2011).
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Implementation Science
Heath informatics
clinical epidemiology
evidence synthesis
communication theory
behavior science
public policy
economics
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What is the Evidence for MDT Care?
• Great variance in the approach and processes of different MDT’s (Meagher, 2013)
• Look Hong, Wright, Gagliardi, et al., (2010) reviewed 21 studies on MDT care and cancer survival:
– No clear evidence that MDT care improves survival
– Some evidence for improved clinician and patient satisfaction
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What is the Evidence for MDTs?
• Audits and surveys demonstrate:
– Reduced time to diagnosis and treatment
– Improved adherence to guidelines
– Improved inclusion in clinical trials
– Improved patient satisfaction
– Improved education and collegiality for clinicians (Cancer Institute, NSW, 2010)
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Draft Guidelines for MDTs in NSW
Broad domains for performance include:
– Team membership
– Team governance and organisation
– Best practice care
– Data collection and documentation
– Communication with GP
– Patient centred care
– Team Development and quality improvement
(Cancer Institute NSW, 2013)
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Current Study
PHASE 1
observations
semi structured interviews,
Priority Setting
Barrier & Enabler Analysis
PHASE 2 Implementation
Interventions
PHASE 3
key research performance indicators /
metrics
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Phase 1 Methods
• Observations (N=43) of several MDT tumor streams:
– Lung
– UGIT
– LGIT
– Gynae Onc
– Breast
– Breast metastatic
– Urology
• Semi Structured Interviews (N=18)
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Phase 1 Broad Findings
• Most MDTs use T2 research and some generate it
• Small number generate T1 research
• Very few MDTs active in T3 research or quality improvement
• Awareness of T3 research is low
• The relationship of MDTs versus individual (s) in research is unclear
• Not all disciplines appear equally research active
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Gap Analysis
• Unclear role for MDTs in QI – no formal process for identifying gaps/ improvement issues
• Lack of T3 leadership – most research clinical trials
• Access to integrated & longitudinal data challenging
• Coordination & support for MDT meetings varies
• Regularity and existence of business / research meetings varies (no forum for fielding questions)
• Regular audit and feedback, e.g., treatment responses not routine
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Key Enabling Factors
• Academic leadership/ capacity in T3 research
• Integrated data
• Interprofessional collaboration / learning
• Regular business meetings
• Research fellows (T3)
• Processes for problem identification / QI
• Medical students
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Conclusions
• A single method usually insufficient to cause change -strategies need to be multi faceted (Grol, 2013).
• Formal processes for gap identification needed (QI links and regular audit and feedback)
• Formal processes for data collection and integration essential
• More interventions do not automatically lead to greater success – how to ID key ingredients?
• Need to raise awareness of practice based research methods
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REFERENCES
• Ebener, S.A., Khan, R., Shademani, L., Compernolle, M., Beltran. M., et al., (2006). Knowledge Mapping as a Technique to Support Knowledge Translation. Bulletin of the World Health Organisation. 84(8):636-42.
• Grol, R., & Wensing, M. (2013). Principles of Implementation in Change, in Grol, R., Wensing, M., Eccles, M. & Davis, D. (Eds). Improving Patient Care: The Implementation of Change in Health Care (2nd Edition). John Wiley & Sons.
• Lamb, B.W., Wong, H.W.L., Vincent, C., Green, J.S.A., Sevdalis, N. (2011). Teamwork and team performance in multidisciplinary cancer teams: Development and evaluation of an observational assessment tool. BMJ Qual Safety, 20: 849-856.
• Lock Hong, NJ; Wright, FC; Gagliardi, AR; Paszat, LF (2010). Examining the potential relationship between multidisciplinary cancer care and patient survival: An international literature review. J. Surg. Oncol, 102 (125-34)
• Meagher, A.P. (2013). Colorectal cancer: are multidisciplinary team meetings a waste of time? ANZ Journal of Surgery, 83 (101-108).