Innovations conference 2014 dr tracy robinson using a multidisciplinary program of cancer care as...

Using a Multidisciplinary Program

Of Cancer Care as a Vehicle for Research Translation

Tracy Robinson (PhD; BA Hons; RN)

OUR TEAM

• Professor Paul Harnett - Director, Sydney West TCRC

• Ms Pamela Provan - Manager, Sydney West, TCRC

• Assoc Prof Tim Shaw - Director, WEDG, USyd

• Dr Tracy Robinson – Research Fellow (USyd & SW TCRC)

• Kylie Museth (Innovations Manager, SW TCRC)

• Ms Anna Janssen -Project Manager, (Usyd & SW TCRC)

• Dr. Karin Lyons - Research Support Officer (WM)

• Dr Jenny Shannon – Nepean Hospital

• Dr Peter Flynn – Nepean Hospital

• Dr Julie Howle – Westmead Hospital

Our Place

Sydney West Cancer NetworkComprehensive cancer services network treating

~4000 new cancer patients, over 130000

outpatients and 6000 inpatients annually.

Westmead Millennium InstituteIndependent research institute with over 420

research staff attracting over $20 million in

research grant funding annually.

Sydney West

• MDT’s are primary vehicle for delivering cancer care in Sydney West

• MDT meetings only one aspect of wider program in cancer care (clinical networks, registrar training etc.)

• Significant investment of time and resources

• Important to define their composition, processes (such as how they document and make decisions)

• Supported by establishment of the Sydney West TCRC

MDTs as Vehicles for Translational Research

• implementation science complex - involves identifying type of knowledge, perceived relevance, clinicians & the health care setting (Ebener et al., 2006).

• What is the role of MDTs in implementation science and translational research?

• variability in the performance of MDTs

• What is the type and extent of variation that is acceptable or even desirable in MDTs? (Lamb et al., 2011).

Implementation Science

Heath informatics

clinical epidemiology

evidence synthesis

communication theory

behavior science

public policy

economics

What is the Evidence for MDT Care?

• Great variance in the approach and processes of different MDT’s (Meagher, 2013)

• Look Hong, Wright, Gagliardi, et al., (2010) reviewed 21 studies on MDT care and cancer survival:

– No clear evidence that MDT care improves survival

– Some evidence for improved clinician and patient satisfaction

What is the Evidence for MDTs?

• Audits and surveys demonstrate:

– Reduced time to diagnosis and treatment

– Improved adherence to guidelines

– Improved inclusion in clinical trials

– Improved patient satisfaction

– Improved education and collegiality for clinicians (Cancer Institute, NSW, 2010)

Draft Guidelines for MDTs in NSW

Broad domains for performance include:

– Team membership

– Team governance and organisation

– Best practice care

– Data collection and documentation

– Communication with GP

– Patient centred care

– Team Development and quality improvement

(Cancer Institute NSW, 2013)

Current Study

PHASE 1

observations

semi structured interviews,

Priority Setting

Barrier & Enabler Analysis

PHASE 2 Implementation

Interventions

PHASE 3

key research performance indicators /

metrics

Phase 1 Methods

• Observations (N=43) of several MDT tumor streams:

– Lung

– UGIT

– LGIT

– Gynae Onc

– Breast

– Breast metastatic

– Urology

• Semi Structured Interviews (N=18)

Phase 1 Broad Findings

• Most MDTs use T2 research and some generate it

• Small number generate T1 research

• Very few MDTs active in T3 research or quality improvement

• Awareness of T3 research is low

• The relationship of MDTs versus individual (s) in research is unclear

• Not all disciplines appear equally research active

Gap Analysis

• Unclear role for MDTs in QI – no formal process for identifying gaps/ improvement issues

• Lack of T3 leadership – most research clinical trials

• Access to integrated & longitudinal data challenging

• Coordination & support for MDT meetings varies

• Regularity and existence of business / research meetings varies (no forum for fielding questions)

• Regular audit and feedback, e.g., treatment responses not routine

Key Enabling Factors

• Academic leadership/ capacity in T3 research

• Integrated data

• Interprofessional collaboration / learning

• Regular business meetings

• Research fellows (T3)

• Processes for problem identification / QI

• Medical students

Conclusions

• A single method usually insufficient to cause change -strategies need to be multi faceted (Grol, 2013).

• Formal processes for gap identification needed (QI links and regular audit and feedback)

• Formal processes for data collection and integration essential

• More interventions do not automatically lead to greater success – how to ID key ingredients?

• Need to raise awareness of practice based research methods

THANK YOU

Tracy.robinson@sydney.edu.au

REFERENCES

• Ebener, S.A., Khan, R., Shademani, L., Compernolle, M., Beltran. M., et al., (2006). Knowledge Mapping as a Technique to Support Knowledge Translation. Bulletin of the World Health Organisation. 84(8):636-42.

• Grol, R., & Wensing, M. (2013). Principles of Implementation in Change, in Grol, R., Wensing, M., Eccles, M. & Davis, D. (Eds). Improving Patient Care: The Implementation of Change in Health Care (2nd Edition). John Wiley & Sons.

• Lamb, B.W., Wong, H.W.L., Vincent, C., Green, J.S.A., Sevdalis, N. (2011). Teamwork and team performance in multidisciplinary cancer teams: Development and evaluation of an observational assessment tool. BMJ Qual Safety, 20: 849-856.

• Lock Hong, NJ; Wright, FC; Gagliardi, AR; Paszat, LF (2010). Examining the potential relationship between multidisciplinary cancer care and patient survival: An international literature review. J. Surg. Oncol, 102 (125-34)

• Meagher, A.P. (2013). Colorectal cancer: are multidisciplinary team meetings a waste of time? ANZ Journal of Surgery, 83 (101-108).