Feasibility study of multidisciplinary oncology rounds by videoconference for surgeons in remote locales

BACKGROUND: This study was undertaken to assess the feasibility of using videoconferencing to involve community-based surgeons in interactive, multidisciplinary oncology rounds so they may benefit from the type of community of practice that is usually only available in academic cancer centres. METHODS: An existing videoconference service provider with sites across Ontario was chosen and the series was accredited. Indirect needs assessment involved examining responses to a previously conducted survey of provincial surgeons; interviewing three cancer surgeons from different regions of Ontario; and by analyzing an online portfolio of self-directed learning projects. Direct needs assessment involved a survey of surgeons at videoconference-enabled sites. A surgical, medical and radiation oncologist plus a facilitator were scheduled to guide discussion for each session. A patient scenario developed by the discussants was distributed to participants one week prior to each session. RESULTS: Direct and indirect needs assessment confirmed that breast cancer and colorectal cancer topics were of greatest importance to community surgeons. Six one-hour sessions were offered (two breast, two colorectal, one gynecologic and one lung cancer). A median of 22 physicians and a median of eight sites participated in each session. The majority of respondents were satisfied with the videoconference format, presenters and content. Many noted that discussion prompted reflection on practice and that current practice would change. CONCLUSIONS: This pilot study demonstrated that it is possible to engage remote surgeons in multidisciplinary oncology rounds by videoconference. Continued assessment of videoconferencing is warranted but further research is required to develop frameworks by which to evaluate the benefits of telehealth initiatives

Conceptual and socio-cognitive support for collaborative learning in videoconferencing environments

Studies have shown that videoconferences are an effective medium for facilitating communication between parties who are separated by distance. Furthermore, studies reveal that videoconferences are effective when used for distance learning, particularly when learners are engaged in complex collaborative learning tasks. However, as in face-to-face communication, learners benefit most when they receive additional support for such learning tasks. This article provides an overview of three empirical studies to illustrate more general insights regarding some of the more and less effective ways of supporting collaborative learning with videoconferencing. The focus is on conceptual support, such as structural visualization and socio-cognitive support, such as scripts. Based on the results of the three studies, conclusions can be drawn about the conceptual and socio-cognitive support measures that promote learning. Conclusions can also be reached about the need for employing both conceptual and socio-cognitive support to provide learners with the most benefit

Challenges in multidisciplinary cancer care among general surgeons in Canada

<p>Abstract</p> <p>Background</p> <p>While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings.</p> <p>Methods</p> <p>General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses.</p> <p>Results</p> <p>The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care.</p> <p>Conclusion</p> <p>General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.</p

“Ruolo dei Tumor Board virtuali nella gestione dei pazienti oncologici in Sicilia”

Introduction: Virtual Multidisciplinary Tumor Boards (VMTBs) facilitate multidisciplinary cancer care and could be essential to reinforce oncological networks especially in a vast geographical area like Sicily. Moreover, the Covid- 19 pandemic has altered the way of approaching the patient and virtual meetings helped to avoid interpersonal contact and, on the other side, to optimize the clinical information flows within the regional healthcare network. This pilot observational study assessed the feasibility and acceptance of using telemedicine to implement a cloud-based virtual tumor board program within Sicily. Patients and Methods: The VMTB program was implemented through a cloud- based platform (Navify, Roche; Basel, Switzerland). Feasibility, acceptability, and suitability were assessed via validated survey (1–5-point Likert scale), administered to 72 VMTB participants. The Secondary Endpoints included the preliminary data on VMTB meetings utilization and the effectiveness in providing access to quality and equitable cancer care including timely and appropriate multidisciplinary evaluation. Results: Overall, 365 patients were referred to the virtual conferences over an 18-month observation period. Nearly the 48% of cases came from general hospitals and tertiary centers, the 35% were referred from the comprehensive cancer centers and the 17% were referred from the teaching hospitals. Three cancer groups were formed: Prostate Cancer Group (PCG), Gynecological Cancer Group (GCG) and Lung Cancer Group (LCG). The majority of participants (96%) assumed, through the survey, that the VMTB could eliminate the geographical barriers and could improve the equity of care. Most of the prostate cancer patients had a stage III (45%) and IV (34%) of disease, while most Gynecological cancer patients and lung cancer patients had a stage III and IV of disease. The more discussed topics in the PCG, the GCG and the LCG were radiology findings followed by the medical treatment in the PCG and GCG, and the surgical treatment in the LCG. In the PCG, GCG and LCG respectively the 71%, 68% and 64% of the clinical cases discussed had no change in the diagnostic-therapeutic work-up after the virtual conferences. All the final recommendations electronically voted at the end of each meeting were controlled for adherence to the guidelines; the appropriateness of the VMTB assessment was of 98%. The majority of VMTB meetings (80%) were presented in a timely fashion; mean time from the consult request to the clinical case discussion was 7.3 business days. Conclusion: VMTB’s development is feasible and highly accepted by its participants. However, virtual conferences cannot necessarily replace traditional meetings because the VTBMs have still to overcome many barriers. Future studies should focus on widespread implementation and validating the effectiveness of this model

Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

Objectives Given the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient. Design A sequential mixed-method study. Setting One oncology centre and its partner in the Northern part of the Netherlands. Participants Head-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner. Primary and secondary outcome measures Percentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT. Results In eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fresh perspective by hearing the case 'as new'. The teams recognise the importance of keeping their medical viewpoints aligned, but the requirement (that the partner should discuss all patients) was seen as outdated. Conclusions The added value of the video-conferenced MDT is small considering patient care, but the specialists recognised that it is important to keep their medical viewpoints aligned and that their patients benefit from the discussions on complex cases

Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

OBJECTIVES: Given the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient. DESIGN: A sequential mixed-method study. SETTING: One oncology centre and its partner in the Northern part of the Netherlands. PARTICIPANTS: Head-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner. PRIMARY AND SECONDARY OUTCOME MEASURES: Percentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT. RESULTS: In eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fre

An evaluation of Colorectal Cancer multidisciplinary team meetings

The management of Colorectal Cancer has evolved, and in many parts of the world is provided by multidisciplinary teams (MDTs). In the UK all patients with colorectal cancer have their management discussed at MDTs. This thesis presents a series of mixed method studies aimed at developing and utilising methods to evaluate and assess the functioning of Colorectal Cancer MDTs. The introduction presents an overview Colorectal Cancer and the role of MDTs. Chapter 2 presents a systematic review and meta-analysis of studies on Colorectal Cancer MDTs. Chapter 3 explores the views of core members of Colorectal Cancer MDTs on potential assessment tools. Chapter 4 concludes this section with an analysis of the costs involved with these teams. In Chapter 5 I describe the development and validation of an observational tool for evaluation of Colorectal Cancer MDTs, followed by an evaluation of the relationships between decision making within the team and the various aspects of the tool described in Chapter 6. Chapter 7 presents the feasibility of reliably using this tool for video based assessments of Colorectal Cancer MDTs. I conclude this thesis with a general discussion – focussing on relevant findings, clinical implications of my work and directions for future research.Open Acces

Multidisciplinary oncology care pathways, evaluation of organisational interventions

In het proefschrift van Van Huizen worden de reorganisatie van multidisciplinaire medische overleggen (MDO’s) en video-confereren (VC) geëvalueerd. Het bleek dat door de invoering van een multidisciplinair eerste-dag spreekuur voor hoofd-hals-kanker en de reorganisatie van het gastro-intestinale oncologische MDO, de efficiëntie van de zorgtrajecten, vooral de wachttijd tot behandeling, verbeterde. Daarnaast bleek dat bij multidisciplinaire behandelingen het informeren van de patiënt extra aandacht verdient en wensen steeds moeten worden meegewogen.Zes verschillende vormen van VC in oncologische netwerken werden geïdentificeerd. De toepassingen van VC varieerde van ad hoc overleg met experts over behandeling van complexe casussen of zeer zeldzame tumoren, tot regulier overleg tussen zorgprofessionals, bijvoorbeeld in de palliatieve zorg. Voordelen van VC voor patiënten waren minder reizen voor diagnostisch onderzoek, betere coördinatie van zorg, betere toegang tot schaarse voorzieningen en behandeling in de eigen regio. Voordelen voor zorgmedewerkers waren optimalisatie van behandelplannen door multidisciplinaire discussies van complexe cases, tegelijkertijd informeren van zorgmedewerkers over wijzigingen in het zorgplan voor individuele patiënten en medische ontwikkelingen, verbeterde zorgcoördinatie en minder reizen.Het reguliere VC-MDO Hoofd-Hals Oncologie tussen een Universitair Medisch Centrum Groningen en haar partner Medisch Centrum Leeuwarden bleek vooral van waarde voor het bespreken van complexe casussen, omdat het andere team er met een ‘frisse blik’ naar keek, en voor het afstemmen van medisch beleid. Voor de aansturing van een zorgtraject bleek er behoefte te zijn aan een ‘real-time dashboard’ betreffende diagnostische procedures en behandelplannen. De meerwaarde van zo’n dashboard zou in toekomstig onderzoek geëvalueerd moeten worden.Van Huizen's dissertation evaluates the reorganisation of multidisciplinary meetings (MDTMs) and video-conferencing (VC). It turned out that introduction of a multidisciplinary first-day consultation for head-and-neck cancer and reorganisation of the gastrointestinal oncological MDTM improved the efficiency of the care pathway, particularly waiting times to start treatment. It was shown that in case of multidisciplinary treatment, extra attention should be paid to informing the patient and that wishes should always be taken into consideration.Six different types of VC in oncology networks were identified. Applications ranged from ad hoc consultation with experts about complex cases or very rare tumours to regular meetings about e.g. palliative care. Benefits for patients were, less travel, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals involved optimised treatment plans through multidisciplinary discussion of complex cases, the ability to inform all healthcare professionals simultaneously on developments in the care of individual patients, enhanced care coordination, less travel and continued medical education.The regular VC-MDTM Head-and-Neck Oncology between Groningen University Medical Centre and its partner Leeuwarden Medical Centre added value in discussing complex cases, because the other team offered a fresh perspective by hearing it ‘as new’ and in in keeping their medical viewpoints aligned.For management of a care pathway, there was a need for real-time information regarding diagnostic procedures and treatment plans in the form of a ‘real time dashboard’. The added value of such a dashboard should evaluated in future research

La collaboration interprofessionnelle au sein de communautés de pratique œuvrant auprès de patients atteints de maladies chroniques : synthèse des expériences rapportées dans la littérature

Le système de santé est aujourd’hui marqué d’une complexité attribuable aux maladies chroniques, dont la hausse anticipée de la prévalence génère l’urgence d’une organisation et d’une approche différentes des services dispensés. Ce réaménagement des soins de santé fait appel à un changement de paradigme basé sur la collaboration interprofessionnelle et l’ouverture à l’incertitude, aptes à favoriser une mise en commun des connaissances. Dans cette perspective, les communautés de pratique (CdeP) semblent un moyen qui favorise le développement de la collaboration interprofessionnelle et le partage des connaissances. Elles apparaissent donc comme une formule qui mérite une investigation, à savoir si elles peuvent favoriser une telle collaboration et faciliter la co-construction de connaissances permettant une pratique évolutive, centrée sur le patient. Notre recherche s’inscrit dans cette optique et s’intéresse aux expériences, rapportées dans la littérature, de collaboration interprofessionnelle au sein de communautés de pratique centrées sur le patient atteint de maladie chronique. Pour ce faire, nous avons d’abord développé un cadre conceptuel visant à identifier les fondements théoriques et conceptuels de la notion de communauté de pratique. Ceci nous a amené à : 1) analyser l’évolution du concept de CdeP dans les principales œuvres de Wenger et de ses collaborateurs; 2) positionner les CdeP eu égard à d’autres formules de travail collaboratif (communauté, communauté d’apprentissage, communauté apprenante, organisation apprenante, communauté épistémique); 3) comparer le concept de collaboration avec d’autres s’en rapprochant (coopération notamment), de même que les notions d’interdisciplinarité et d’interprofessionnalité souvent associées à celle de CdeP; 4) étayer les dimensions cognitive et collaborative inhérentes aux expériences de CdeP; et 5) identifier les avancées et les limites attribuées à la mise en application du concept de CdeP dans le domaine de la santé. La métasynthèse (Beaucher et Jutras, 2007) dans une approche « compréhensive interprétative », s’est imposée comme méthode appropriée à notre intention de mieux saisir les expériences de collaboration interprofessionnelle menées dans le cadre des CdeP dans le domaine de la santé. La métasynthèse nous a ainsi permis d’obtenir une vue d’ensemble de la littérature portant sur les CdeP dans le domaine de la santé et de catégoriser les 194 articles rassemblés, pour ensuite retenir 13 articles traitant d’une réelle expérience de CdeP. Ainsi, dans une perspective contributoire, basée sur notre cadre conceptuel, l’analyse des principaux résultats de la métasynthèse, nous a permis 1) d’identifier les flous conceptuels liés aux expériences de CdeP rapportées, ainsi que 2) de dégager les retombées et les difficultés de leur mise en application dans le domaine de la santé et, enfin, 3) de démontrer la nécessité de mener des recherches visant l’étude du processus de développement de CdeP sur le terrain de la pratique de soins, notamment mais non exclusivement, lorsqu’il s’agit de maladies chroniques.Today’s health system is increasingly complex due to the growth of chronic illnesses. The anticipated increase in the prevalence of chronic illnesses means there is an urgent need for a different type of organization and approach to providing services to the patient. This adjustment in health care delivery calls for a paradigm shift based on inter-professional collaboration and openness to uncertainty, which will in turn facilitate knowledge sharing. In this regard, communities of Practice (CoP) appear to be a way to facilitate the development of inter-professional collaboration and the sharing of knowledge, and therefore merit further investigation in order to determine whether or not they can foster such collaboration and facilitate the co-construction of knowledge leading to an evolving practice that is patient oriented and adapted to complexity. Our research is consistent with this view and is driven by an interest in the interprofessional collaboration experiences, as reported in litterature, that have taken place as part of communities of practice and have centred on patients suffering from chronic illnesses. In order to achieve this, we first developed a conceptual framework with the aim of identifying the theoretical and conceptual foundations of communities of practice. This has led us to 1) analyze the evolution of the concept of communities of practice in the major works of Wenger and of his collaborators; 2) position communities of practice by comparing them to other forms of collaborative work with which they are frequently associated and even substituted or mistaken for in the literature (such as community, learning community, learning organization, epistemic community); 3) compare the concept of collaboration with other similar concepts (including collaboration), as well as the notions of interdisciplinarity and inter-professionalism often associated with communities of practice; 4) support the cognitive and collaborative dimensions inherent to communitied of practice; and 5) identify the advances and limitations attributed to the implementation of the concept of communities of practice in the health field. Metasynthesis (Beaucher et Jutras, 2007) ), as part of a ‘‘comprehensive interpretative’’ approach, was determined to be the most appropriate research method for understanding the experiences of interprofessional collaboration as part of communities of Practice in the health field.. Metasynthesis provided us with an overview of the literature on the subject of CoP in the health field and allowed us to create a topology of the 194 collected articles. This overview led to the selection of 13 articles describing real experiences of CoPs. As such, in terms of contribution, this metasynthesis enabled us to 1) identify the reported conceptual vagueness associated with the implementation of CoPs; 2) identify the benefits and challenges of their implementation in the field of health; and 3) demonstrate that further research on the development process of communities of practice in the field of care practice, including but not limited to situations involving chronic illnesses, is necessary