JMIR Publications

ABSTRACT

Introduction Cancer treatment is constantly evolving towards a more personalised approach based on clinical features, imaging and pathology genomic information. To ensure the best care for patients, multidisciplinary teams (MDT) meet regularly to review cases. Notwithstanding, conducting MDT meetings is challenged by medical time restriction, unavailability of critical MDT members, and the additional administrative work required. To explore and facilitate improved approaches for MDT meetings in France, using advanced breast cancers (ABC) as a model, the Centre Leon Berard and ROCHE Diagnostics® have co-created an MDT application prototype based on structured data. Methods Prior to the initiation of co-creation activities, an organizational audit of ABC MDT meetings, recognized three key phases for the MDT, namely the preparation, execution and follow-up. For each phase, challenges and opportunities were identified which informed the new co-creation activities. The MDT application prototype became software that integrated structured data from the medical file to visualise the neoplastic history of a patient. Results The ABC MDT audit was carried out during three MDT meetings including 70 discussions of clinical cases before and 58 after the implementation MDT application prototype. We identify 33 pain points related to the preparation, execution and follow-up phases. Difficulties were grouped as follows: process challenge (16), technological limitation (11) and lack of available resources (6). Repeat audit, undertaken after the implementation of the MDT application, demonstrated: 1) Discussion time per case remained comparable (2:22 mins vs 2:14 mins), 2) Improved capture of MDT decisions (100% of cases included a therapeutic proposal), 3) No postponement of treatment decisions, and 4) Increased mean confidence of medical oncologists in decision-making. Discussion/Conclusion Introduction of the MDT application prototype at CLB to support the ABC MDT seems to improv the quality and confidence of clinical decisions. Integration, of an MDT application with the local electronic medical record and the utilisation of structured data conforming to international terminologies, could enable a national network of MDTs to support sustained improvements to patient care.