Therapeutic decision making and the multidisciplinary team

Therapeutic decision making and the multidisciplinary team

As the management of cancer becomes more complex, it becomes impossible for an individual clinician to have the competence that is necessary to manage all patients presenting with a particular type of tumour. The formation of multidisci plinary teams represents an attempt to make certain that each and every patient with a particular type of cancer is managed appropriately . Teams should not only be multidisciplinary – they should also be multiprofessional. The advantages and disadvantages of multidisciplinary teams are summarised in Table 12.4 . The multidisciplinary team needs to answer three basic questions for every patient: /uni25CF What is the patient’s diagnosis, stage and molecular char acteristics of disease? /uni25CF What is the goal of treatment for the patient? In simple terms, this can be divided into cure, prolongation of life and palliation of symptoms. /uni25CF What treatment options are there to achieve these aims with the fewest possible side e ff ects? Options may include surgery , radiotherapy , anti-cancer systemic (drug) treat ment, symptom control measures, a combination of these options and, in some cases, observation. makes recommendations, rather than definite treatment deci - sions. Several other factor s must be considered, which can only be done by a clinician making a direct assessment of the patient’s health and wishes. The clinician must ascertain the - patient’s fitness and hence their ability to tolerate treatment. This will be heavily influenced b y comorbidities. Patients vary er, greatly in their willingness to tolerate treatment for a given - benefit and particularly how they value quality of life com - pared with length of life or chance of cure. There are often several possible treatment plans and the clinical team must take the time to explain the options care - fully to the patient and the patient’s supporters. In many can - - cer centres, there will be both standard-of-care and resear ch options available for patients. Explanations should include what is involved in the treatment, what benefits may r esult and the chance of the patient receiving those benefits. The clinical team must also explain the possible downsides of treatment and the likelihood of experiencing them. Patients are often faced with a large amount of complex and di ffi cult informa - tion at a time when they are extremely vulnerable. The clinical team must support patients to reach a decision and this may take time and repeated explanation. -

TABLE 12.4 The advantages and disadvantages of the multidisciplinary team. Advantages Open debate concerning management of complex patients with many specialists Decision making is open, transparent and explicit Team members educate each other A useful educational experience for trainees and students Performance can be monitored by managers