Journal
INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE
Volume 28, Issue 3, Pages 332-338Publisher
OXFORD UNIV PRESS
DOI: 10.1093/intqhc/mzw030
Keywords
cancer; quality assessment; observation; multidisciplinary team; patient care team; teamwork
Funding
- National Cancer Action Team (NCAT)
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust
- Guy's and St Thomas' NHS Foundation Trust
- King's College Hospital NHS Foundation Trust
- King's College London and South London and Maudsley NHS Foundation Trust
- Guy's and St Thomas' Charity
- Maudsley Charity
- Health Foundation
- NCAT
- King's College London
- Green Cross Medical Ltd.
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Objective: To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. Design: Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. Setting: Study 2 included 10 cancer MDMs in England. Participants: Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. Intervention: None. Main Outcome Measures: Tool development, validity, reliability/agreement and variability in MDT performance. Results: Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance (P <= 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (>= 80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6-7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs (P <= 0.01). Conclusions: MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance.
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