MULTIDISCIPLINARY TEAM (MDT) SUPPORT PROJECT WITH CANCER CENTRE LUNG TEAM

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1 MULTIDISCIPLINARY TEAM (MDT) SUPPORT PROJECT WITH CANCER CENTRE LUNG TEAM

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3 NICaN ACKNOWLEDGEMENT This Multidisciplinary Team (MDT) Support report has been produced in conjunction with Dr Richard Shepherd and team at the Cancer Centre. Thanks must go to the following people for taking time out of their already full schedules, to provide assistance and input into this Report. Dr Richard Shepherd Clinical Director for A&CLM and Lead Lung Cancer Clinician, Belfast City Hospital Beth Malloy Planning Manager, Belfast City Hospital Lesley Rutherford - Specialist Nurse Lung Cancer, Belfast City Hospital Members of the Cancer Centre Lung MDT Elaine Lorimer - Dr Shepherd s Secretary, Belfast City Hospital Trudi Coyne Specialist Nurse Gynaecology, Belfast City Hospital Sheila McGreevy Dr Price s Secretary, Belfast City Hospital Members of the Belfast City Hospital Gynae MDT Members of the Altnagelvin Lung and GI MDTs Dr Dermot Hughes and the Team in the Oncology Department of Altnagelvin Hospital Michelle Morrow Urology Secretary, Belfast City Hospital Liz Alsbury Service Development Manager, Peninsula Cancer Network Kathleen Lowson Co-ordinator, South East Scotland Cancer Network (SCAN), and Maureen Brindley Thoracic Surgery Co-ordinator and Lung MDT Co-ordinator, Wythenshawe Hospital Manchester. The production of this report has been an extremely useful exercise providing a multitude of useful information and resources - which we believe will have relevance for MDTs operating throughout the region Lisa McWilliams, NICaN Administrator, compiled this report. (l.mcwilliams@nican.n-i.nhs.uk)

4 NICaN EXECUTIVE SUMMARY This Report identifies the administrative and other support requirements and provides guidance and recommendations for the effective operation of a Multidisciplinary Team (MDT) and its meetings. What is an MDT? From the patient s point of view an MDT is primarily a group of people of different health care disciplines, who meet at a certain time (whether physically in one place, or by video or tele-conferencing) to discuss his/her case and who are each able to contribute independently to the diagnostic, treatment or care decisions. By striving to make Multidisciplinary Team Meetings (MDMs) work efficiently, the person with cancer is placed right at the center of the team s efforts to deliver the most suitable treatment with the least delay, thereby contributing to improved outcomes. This report was informed by a range of people and activities including; observations at multidisciplinary team meetings (MDMs), shadowing of an MDT Co-ordinator, discussions with MDT team members, meetings with those who provide varying levels of support for MDTs, analysis of a questionnaire completed by members of the Cancer Centre s Lung MDT - as well as investigating national guidance and examining good practice from MDTs operating in England and Scotland. Types of support repeatedly identified as required for effective MDTs include; Administrative / secretarial support (pre, during and post MDMs) Resources (time; appropriate technology for presenting patient s scans, x-rays, histopathology slides etc.; video/tele conferencing; suitable meeting rooms etc) Audit and data collection support (Both personnel and IT systems to capture meaningful and useful data, which would ideally be regionalised) Training (purpose of MDT, roles of MDT members in MDMs, communication skills, effective team work etc.) The level of administrative/secretarial support is the area with the greatest disparity across Northern Ireland. At one end of the spectrum is a Unit which has a MDT Co-ordinator, supported by three administrative posts, providing extensive support to the MDTs before, during and post 2

5 NICAN MDT SUPPORT REPORT AUGUST 2004 MDMs. At the other end of the spectrum there are MDTs who are operating with little or no support. This report contains examples of the types of administrative and secretarial support provided to MDTs and their MDMs together with an indication of hours involved and grade of person. Audit and data collection support have repeatedly been identified as the priority area for MDT team members. Training to encourage fully inclusive team working and improved communication skills has also been identified as a priority. Taking guidance from already established good practice, national MDT measures and input from MDT personnel, this Report makes ten recommendations for the support of effective and efficient MDTs and their MDMs. 1. All MDTs should have dedicated non-clinical support personnel to provide support pre, during and post MDM. Duties carried out by this postholder could include general MDM support duties, strategic/service improvement duties and data collection duties (see pages for details). It is preferable that MDTs also have access to technicians and IT support personnel. 2. The non-clinical support post be graded appropriately to reflect the skills and competencies required to fulfil the duties of the post holder as outlined in Table 5, page 31. Consideration should also be given to the points discussed on pages Guidance on MDTs as stated in the Revised Manual of Cancer Services 2004 should be followed until Northern Ireland Standards are developed. Details of the standards contained within the Manual of Cancer Services can be viewed at 4. MDT membership should be developed around the patient journey to allow all relevant personnel to play an active part in discussing treatment plans and care of the patient. 5. Strong emphasis needs to be placed on the importance of MDTs and this should be reflected within clinician s contracts - where dedicated time should be allocated for MDM preparation and attendance. 6. MDTs should have access to - imaging equipment and other technology, which allows for all relevant information to be presented and discussed at the MDM; 3

6 NICaN - video/tele conferencing equipment to enable full participation without the restrictions on time from travelling; and - venues which have sufficient space, appropriate imaging and IT equipment, and are conducive to full participation. 7. Each MDT should have adequate systems for recording decisions made at meetings and ensuring that appropriate action is taken to carry out these decisions. Information and decisions about individual patients should be recorded on an appropriate proforma ideally this should be recorded at the MDM. 8. MDT members, including the Chair, should have access to training to encourage fully inclusive team working, better communication, participation at MDMs and effective management/chairing of meetings. 9. MDTs should develop clear policies for the communication of decisions made at MDMs, information provided to patient and the appropriateness of referrals to GPs or referring clinicians 10. MDT members should have an agreed policy for communicating outcomes of MDM to patients and their family/carers. It is hoped that the examples of good practice and the sample job descriptions and multiple MDT proformas (contained within the appendices) in this Report will be a useful resource for developing MDTs at the Units and Centre within Northern Ireland. 4