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Lookup NU author(s): David Hamilton, Dr Ben Heaven, Dr Richard Thomson, Emerita Professor Janet WilsonORCiD, Professor Catherine Exley
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. OBJECTIVES: To describe how patients are engaged with cancer decisions in the context of multidisciplinary team (MDT) and how MDT recommendations are operationalised in the context of a shared decision. DESIGN: Ethnographic qualitative study. SETTING: Four head and neck cancer centres in the north of England. PARTICIPANTS: Patients with a diagnosis of new or recurrent head and neck cancer; non-participant observation of 35 MDT meetings and 37 MDT clinics, informal interviews, and formal, semistructured interviews with 20 patients and 9 MDT staff members. METHODS: Ethnographic methods including non-participant observation of MDT meetings and clinic appointments, informal interviews, field notes and formal semistructured interviews with patients and MDT members. RESULTS: MDT discussions often conclude with a firm recommendation for treatment. When delivered to a patient in clinic, this recommendation is often accepted by the patient, but this response may result from the disempowered position in which they find themselves. While patient behaviour may thus appear to endorse clinicians' views that a paternalistic approach is desired by patients (creating a 'cycle of paternalism'), the rigidity of the MDT treatment recommendation can act as a barrier to discussion of options and the exploration of patient values. CONCLUSIONS: The current model of MDT decision-making does not support shared decision-making and may actively undermine it. A model should be developed whereby the individual patient perspective has more input into MDT discussions, and where decisions are made on potential treatment options rather than providing a single recommendation for discussion with the patient. Deeper consideration should be given to how the MDT incorporates the patient perspective and/or delivers its discussion of options to the patient. In order to achieve these objectives, a new model of MDT working is required.
Author(s): Hamilton DW, Heaven B, Thomson R, Wilson J, Exley C
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2022
Volume: 12
Issue: 8
Online publication date: 24/08/2022
Acceptance date: 22/07/2022
Date deposited: 05/09/2022
ISSN (print): 2044-6055
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjopen-2022-061654
DOI: 10.1136/bmjopen-2022-061654
PubMed id: 36002202
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