An Exploration of Support for Breast Cancer Patients by Multidisciplinary Teams - Literature review Example

? An Exploration of the Scope and Effectiveness of Support for Breast Cancer Patients by Multidisciplinary Teams ID Number Total Number of Words: 1,099 Appendix: 304 words Introduction This study will focus on answering the question: Is the support given by multidisciplinary teams (MDT) to breast cancer patients effective? To determine the barriers behind a successful decision-making and implementation of MDTs decision and identify strategies that can be use to improve MDT supports to breast cancer patients, search engine of NCBI/Pubmed was used in this study. Outline of Main Themes I. Support for Breast Cancer Patients by MDTs II. Effectiveness of Support for Breast Cancer Patients by MDTs III. Barriers behind a Successful Decision-Making Made by MDTs IV. Barriers behind a Successful Implementation of Decisions Made by MDTs V. Recommended Solutions Literature Review The multidisciplinary teams (MDTs) are composed of different health care professionals (i.e. physicians, breast cancer surgeons, pathologists, radiologists, oncologists, specialist nurses, etc.) who are in-charge of making important clinical decisions for the breast cancer patients (Kesson et al., 2012; Saini et al., 2012; Lamb et al., 2011; Whelan, Griffith and Archer, 2006). In fact, MDTs can work together to improve the quality of pain management services given to these patients (Burnbam, Day and Dudley, 2010). Patkar (2011) also agreed that the presence of MDTs could improve the outcome of treatment for cancer patients. By working closely with one another, the MDTs in UK can offer the best treatment for breast cancer patients (Kesson et al., 2012; Saini et al., 2012; Whelan, Griffith and Archer, 2006). In UK, the presence of MDT management team is mandatory when caring for breast cancer patients (English et al., 2012). Even though MDT intervention is mandatory in UK, several studies pointed out that the presence of MDTs in terms of being able to come up with the best management plan for breast cancer patients is not fully utilized (English et al., 2012; Jalil et al., 2013). For instance, there are cases wherein decisions coming from the MDTs are not properly implemented. To determine the factors that could affect the decision-making and implementation of MDT decisions, Jalil et al. (2013) conducted a semi-structured interviews with 22 MDT members in 3 London-based hospitals only to find out that the barriers behind a successful decision-making include: insufficient clinical information, non-attendance of MDT members, failure to use teleconferencing technology, and the absence of investigation results whereas barriers behind a successful implementation include the fact that most MDTs do not consider the patients’ choice in their preferred care and treatment and the progression of cancer during the implementation stage. English et al. (2012) also revealed that the patients’ preferences (n=13), discovery of new clinical findings (n=3), and the different doctors’ point-of-views (n=4) are among the common reasons why decisions coming from the MDTs can be overruled. Abdulrahman (2011) mentioned that insufficient facilities, poor interprofessional relationships, and time constraint could serve as the barriers behind MDT teamwork. The MDTs has a significant role to play in the delivery of care and treatment to breast cancer patients (i.e. physicians, breast cancer surgeons, pathologists, radiologists, oncologists, specialist nurses, etc.) (Kesson et al., 2012; Saini et al., 2012). In fact, “MDT meetings are effective for treatment planning” (Chae et al., 2012). However, there is a limitation when it comes to the active participation of each MDT members when discussing the case of each breast cancer patient (Jalil et al., 2013; Whelan, Griffith and Archer, 2006). Each week, the MDT members usually meet up to discuss the treatment plan and care management for each breast cancer patient. In each meeting, Whelan, Griffith and Archer (2006) revealed that medical oncologists, radiologists, pathologists, and reconstructive breast surgeons seldom participate in such meetings and that the MDT coordinator is responsible in collecting the case-notes from each pathologist and radiologist which will be used during the weekly meetings. In fact, only 79 out of 134 MDTs discuss the case of each cancer patient whereas only 118 would discuss the case privately with the patients (Griffith and Archer, 2006). According to Meagher (2009), attendance of MDTs may vary depending on the severity of the patients’ illnesses. To further improve the role of MDTs in terms of giving support to breast cancer patients, Lamb et al. (2011) strongly suggest the need to improve the communication line among the health care professionals and the patients. Basically, this can be done by continuously improving the time coordination among the health care professionals and the patients (Lamb et al., 2011). Considering the fact that there is a very high demand for the services offered by these health care professionals, Jalil et al. (2013) highly recommends the need to further improve the access to video-conferencing available to each of the members of the MDTs, lessen the work load of each MDT members, and make it a practice to allow the breast cancer patients to participate in the decision-making process. By removing the communication gap among the health care professionals, it would be so much easier to increase not only the overall satisfaction of breast cancer patients but also increase the effectiveness of MDTs in UK (Lamb et al., 2011). To determine the significance of MDT on the survival rate of breast cancer patients, Kesson et al. (2012) conducted a retrospective, comparative, non-randomised interventional cohort study among 14,358 breast cancer patients between 1990 and 2000 in NHS hospitals. Based on 13,722 breast cancer patients who were qualified in this study, Kesson et al. (2012) found out that care and support coming from MDTs contributed to “18% lower breast cancer mortality rate at five years and 11% lower all cause mortality at five years”. Using a randomized controlled trial method, Jones et al. (2012) compared the impact of rehabilitation intervention given by a hospice-based MDT versus the usual care given to patients with progressive and recurrent breast cancer. Using the psychological subscale of the Supportive Care Needs Survey (SCNS), Jones et al. (2012) conclude that the hospice-based MDT intervention is more effective in terms of reducing the unmet needs of the breast cancer patients. It means that the presence of hospice-based MDT intervention can increase the quality of life of each breast cancer patient. Prognoses or survival estimates are commonly given to patients with advanced stage cancer. In line with this, Gwilliam et al. (2013) compared the ability of the doctors, nurses, and MDTs to give an accurate prognoses or survival estimates on patients with advanced cancer. Based on the research findings, Gwilliam et al. (2013) found out that MDTs (57.5%) are better in terms of predicting the ability of the patients to survive as compared to the doctors (56.3%) and nurses (55.5%). Conclusion and Recommendations The role of MDTs in the provision of care and treatment for breast cancer patients is very important. However, attendance problem and communication gaps make some patients unable to maximize the benefits of having MDTs. To ensure that the breast cancer patients will receive the best care and treatment options, this study highly recommends the need to narrow down communication gap by improving their access to video-conferencing and lessen their overall work load. By doing so, the MDTs will have more quality time to attend to the needs of breast cancer patients. References Abdulrahman, G. (2011). The effect of multidisciplinary team care on cancer management . The Pan African Medical Journal, 9, p. 20. Burnbam, R., Day, J. and Dudley, W. (2010). Multidisciplinary chronic pain management in a rural Canadian setting. Canadian Journal of Rural Medicine, 15(1), pp. 7-13. Chae, B., Bae, J., Song, B. and Jung, S. (2012). Multidisciplinary team approach in breast cancer: a nationwide survey in Korea. Journal of the Korean Surgical Society, 82(6), pp. 340-346. English, R., Metcalfe, C., Day, J., Rayter, Z. and Blazeby, J. (2012). A Prospective Analysis of Implementation of Multi-Disciplinary Team Decisions in Breast Cancer. The Breast Journal, 18(5), pp. 459-463. Gwilliam, B., Keeley, V., Todd, C., Roberts, C., Gittins, M., Kelly, L., et al. (2013). Prognosticating in patients with advanced cancer—observational study comparing the accuracy of clinicians’ and patients’ estimates of survival. Annals of Oncology, 24(2), pp. 482-488. Jalil, R., Ahmed, M., Green, J. and Sevdalis, N. (2013). Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: An interview study of the provider perspective. International Journal of Surgery, DOI: 10.1016/j.ijsu.2013.02.026. Jones, L., FitzGerald, G., Leurent, B., Round, J., Eades, J., Davis, S., et al. (2012). Rehabilitation in Advanced, Progressive, Recurrent Cancer: A Randomized Controlled Trial. Journal of Pain and Symptom Management, S0885-3924(12)00498-8. doi: 10.1016/j.jpainsymman.2012.08.017. Kesson, E., Allardice, G., George, W., Burns, H. and Morrison, D. (2012). Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13?722 women. BMJ, 344, p. e2718. Lamb, B., Allchorne, P., Sevdalis, N., Vincent, C. and Green, J. (2011). The role of the urology clinical nurse specialist in the multidisciplinary team meeting. International Journal of Urological Nursing , 5(2), pp. 59-64. Meagher, D. (2009). Multidisciplinary activities in a community mental health service: relationship to Health of the Nation Outcome Scale scores and diagnosis . The Psychiatrist, 33, pp. 172-175 . Patkar, V., Acosta, D., Davidson, T., Jones, A., Fox, J. and Keshtgar, M. (2011). Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology. International Journal of Breast Cancer, doi:10.4061/2011/831605. Saini, K., Taylor, C., Ramirez, A.-J., Palmieri, C., Gunnarsson, U., et al. (2012). Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Annals of Oncology, 23(4), pp. 853-859. Whelan, J., Griffith, C. and Archer, T. (2006). Breast cancer multi-disciplinary teams in England: much achieved but still more to be done. Breast, 15(1), pp. 119-122. Appendix I – NCBI/Pubmed Search Result The NCBI/Pubmed is one of the online databases that purposely provide a ready access to a wide-range of peer-reviewed journals. In most cases, the peer-reviewed journals that are available from this particular search engine are highly related to the study of medicine. In search for highly relevant materials, the inclusion and exclusion criteria were used in this study. As part of the search inclusion, only those journals that talks about the MDT role and support in breast cancer patients (published between 2012 to 2013) were included in the literature review. Key words: multidisciplinary teams (MDT) support breast cancer patients. I have decided to use the combination of these search terms because the main purpose of this study is to examine the effectiveness and scope of support given by MDTs to breast cancer patients. Number of hits: 3 Key words: barriers multidisciplinary teams breast cancer patients. I have decided to use the combination of these search terms because part of the main theme is to determine factors that can affect the ability of MDTs to support the treatment of breast cancer patients. Number of hits: 2 Key words: multidisciplinary teams breast cancer patients. I have decided to use the combination of these search terms because the main purpose of this study is to examine the effectiveness and scope of support given by MDTs to breast cancer patients. After using the search term “multidisciplinary teams (MDT) support breast cancer patients”, I was able to locate only 3 relevant journals. I thought that by removing the word “MDT” in the search words, I will be able to generate more relevant journals for this study which I eventually did. Had I not decided to remove the words “MDT”, I may not be able to come up with enough journals to meet the study requirements. Number of hits: 42 Read More