CRUK working group MDT effectiveness proposal Mark Beresford

• MDT meetings are primarily clinical business meetings but it is important to ensure that the additional benefits of MDT working are not lost with any proposed changes. – Team working and interaction between multiprofessional staff – Improving operational efficiency of the team by operational review, audit and – service evaluation – Education and learning opportunities particularly for junior staff – Enhanced accrual in to clinical trials

• MDT meetings utilise a significant amount of limited clinical staff time and financial resource • It is imperative that they are effective • A number of ways to improve MDT meetings have been identified and are presented as 10 recommendations

RECOMMENDATION 1 • MDT Proformas should be standardised across regions and include patient preferences, patient understanding and relevant social issues that may influence treatment options

RECOMMENDATION 2 • Completion of an MDT Proforma must be mandatory • The MDT outcome proforma should initiate and facilitate the referral to the treating clinician and therefore needs to include all relevant clinical details

RECOMENDATION 3 • Real time electronic completion of the MDT outcome must take place during MDT meetings • The chairperson should nominate a clinician to check the accuracy of the real time completion of MDT discussion outcome

RECOMMENDATION 4 • For an MDT to function effectively, appropriate infrastructure is required and a meeting room style which encourages participation from all members is essential • For MDT meetings that require members from other clinical sites to participate, video conferencing facilities are mandatory

RECOMMENDATION 5 • Good chairmanship is essential to effectively manage the meeting and ensure appropriate contribution to relevant cases from all members • The role of the Chair should be recognised as a leadership role and therefore should not rotate automatically • There should be a clear agenda and structure for the meeting and the reason for discussion of individual patients should be clear • Adequate training and support should be given to all MDT Chairs; this could be organised on a regional basis to improve consistency The role also needs to be reflected in their job plan. Chairs are expected to attend 66% of MDT meetings

RECOMMENDATION 6 • Full core membership may no longer be appropriate; quoracy should be the measurement for attendance and is mandatory to ensure the quality of discussion at the MDT meeting and informed recommendations • It is recognised that all clinicians involved in treating cancer patients should continue to be active members of an MDT and therefore an alternative minimum attendance is required • 25% should be the minimum attendance • Local arrangements may be required and this target should be seen as a minimum • Where appropriate surgeons may need to attend a greater percentage of MDMs to discuss cases they will operate on

RECOMMENDATION 7 • The MDT is responsible for making care and treatment recommendations based on the information available and consideration by the relevant 4 disciplines • The accountability and responsibility for treatment decisions lies with the clinician and patient, taking into account the recommendations of the MDT

RECOMMENDATION 8 • Treatment decisions compared to MDT recommendations should be the focus of annual audits for every MDT

RECOMMENDATION 9 • Each MDT needs a mortality and morbidity process to ensure all adverse outcomes come back to the whole MDT rather than just being discussed in surgical or oncological silos

RECOMMENDATION 10 • The MDT and MDT meeting should actively manage patient pathways to ensure patients receive treatment in an appropriate time and avoid breaches • For some MDT meetings, a pre–meet may be useful to streamline the MDT meeting, however effective proforma completion would negate the need for a pre-meet