Understanding, measuring and improving clinical decision-making in urological cancer multidisciplinary team meetings

Cancer care in many countries is delivered by healthcare professionals working together as multidisciplinary teams (MDTs). In the UK the delivery of care by MDTs is mandatory. The aims of the research reported here were to investigate the factors that affect the quality of clinical decision-making in MDT meetings, to develop and evaluate tools to measure this process, and to use these tools to evaluate interventions designed to improve the quality of such decisions. The introduction presents an overview of the evidence for clinical decision-making in MDT meetings, before Chapter 2 provides a critical appraisal of existing evidence, focussing on specific factors that affect decision-making by MDTs. My first empirical Chapters have explored the attitudes and experiences of MDT members and patients. Chapters 3 and 4 present analyses of national survey data that explore the views of MDT members from different professional groups across a range of tumour types. Chapters 5 and 6 present data from in-depth exploration of the views of urology MDT members and cancer patients respectively. Chapters 8 and 9 present data from studies that develop and cross-validate an observational tool for the assessment of decision-making in MDT meetings (MDT-MODe). I have used this tool in Chapter 10 to assess the relationship between organisational factors, information use, teamworking and decision-making in urology MDT meetings. Having built up a picture of the factors that are important for good decision-making, Chapter 11 reports a study that uses MDT-MODe to evaluate a multistage intervention to improve the quality of decision-making in urological MDT meetings. Finally, my general discussion reflects on the findings and the wider evidence base, explores the limitations and presents implications of my work for clinical practice, patient care, future research and policy.