Systematic Evaluation of Decision-making in Colorectal Cancer Tumour Board meetings: Development and validation of a Quality assessment tool

S Shah, S Arora, G Atkin, R Glynne-Jones, P Mathur, A Darzi, N Sevdalis

Imperial College London, Barnet Hospital, Mount Vernon Cancer Centre

INTRODUCTION: Tumor board meetings have become an accepted mechanism for decision-making in colorectal cancer management. However the quality of these meetings can be variable resulting in sub-optimal decisions and poor treatment outcomes. This study aimed to systematically examine aspects of colorectal cancer decision-making, so as to develop and validate an evidence-based, user informed tool that could reliably measure the quality of colorectal tumour board meetings.

METHODS AND PROCEDURES: A multi-phased approach comprising of quantitative and qualitative methodology identified the current best evidence on colorectal cancer tumor boards(phase 1: systematic review) and expert user opinion on outcomes measures for assessing how well colorectal cancer tumor boards functioned (phase 2: qualitative semi-structured interviews with 20 Attendings of the tumour board; analysed independently by 2 researchers using emergent theme methodology). This information was used to develop a tool, termed Colorectal Multidisciplinary Team Metric for Observation of Decision-Making (MDT-MODE), which was content and face validated (phase 3; questionnaire study with 27 experts on Colorectal cancer). Finally MDT-MODE was used by two blinded observers to independently assess decision-making in colorectal MDTs (phase 4; observational study, t-test used to analyse whether scores were better than average). Inter-observer reliability was assessed using Intraclass-correlation-coefficient (p<0.05 = significance).

RESULTS: Phase 1 and 2: A total of 26 articles were included in the systematic review. This suggested that tumour boards affect pre-treatment decisions, adherence to guidelines and clinical outcomes. Interviews highlighted that team member contributions alongside the quality of data presented significantly impact upon the decision-making process. This information was used to construct the MDT-MODE assessment tool which measures the presentation of case history, radiological and pathological information, chair’s effectiveness, and contributions to decision making by all members of the tumor board on a 5 point scale(min=1, max=5). Phase 3: The content validity index for MDT-MODE was excellent at 0.82, with each individual item having high content and face validity with experts. Phase 4: 267 patient cases were assessed in 840 minutes of observations across 11 tumor board meetings. Inter-rater reliability was high (ICC = 0.79). Regarding quality of information presented, radiological (mean 4.2, SD. 1.58) and pathological information (mean 3.8, SD 0.92) was significantly above average (p<0.01). Presentation of patient views (mean 2.1, SD 1.28) and psychosocial history (mean 1.8, SD 1.44) was significantly below average (p<0.01). Contributions of the surgeon (mean 4.8, SD 0.54), the oncologist (mean 3.8, SD 1.60), the radiologist (mean 4.4, SD 1.54 and the pathologist (mean 3.4, SD. 0.54) to the decision-making process was rated as above average (all ps<0.01). A decision was reached in 258 /267 cases. In cases where a treatment decision was not reached, absence of a key member of the MDT was noted.

CONCLUSIONS: Colorectal MDT-MODE provides an evidence-based, end-user informed approach to assessing decision-making in the management of colorectal patients. By quantifying the quality of a tumor board meeting, it has the potential to identify areas for improving practice so as to optimize decision making for cancer care.

Session: Podium Presentation

Program Number: S054

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