Virtual multidisciplinary team meetings
What changed?
- In response to the COVID-19 pandemic, cancer care multidisciplinary team (MDT) meetings transformed rapidly from in-person to virtual meetings.1
Impact of change
- Virtual MDTs helped to reduce the risk of exposure to, and harm from, SARS-CoV-2 infection for clinicians.2
- Virtual MDTs has improved the ease of clinician attendance3 and enabled engagement of the MDT with primary care for improved care planning.4
- There is an opportunity for virtual MDTs to become a standard component of future clinical workflows5 including a mixture of in-person and virtual attendance for MDT members to support communication and coordination of care across diverse locations and optimise clinician time.4
How can high-value changes be embedded or enhanced?
The following strategies were identified in Australian and international literature and by leading Australian cancer experts and consumers. This list is provided to prompt considerations and future strategies to support high-value cancer care in the Recovery phases of the COVID-19 pandemic.
These strategies are listed at the system-, service-, practitioner-, and patient-levels and are intended to be used by a range of cancer control stakeholders across Australia to support high-value cancer care and improve outcomes for people with cancer.
System-level strategies
- Supporting greater utilisation of MDTs, in both face-to-face and virtual formats.
- Evaluating the effectiveness and cost-effectiveness of virtual MDTs in urban settings to supplement established evidence in rural settings.5
Service-level strategies
- Strategically investing in information technology infrastructure, and technical and administrative personnel4 to support the workflows of virtual MDTs, including the prioritisation of data security and patient privacy when using digital platforms.6
- Establishing communication linkages, including technical capabilities to allow rapid data transfer, to enable team preparation and participation, integrate decision making, and implement comprehensive care.7
- Evaluating the quality of decision-making of the virtual MDT, as compared to the face-to-face format, in improving guideline adherence and patient outcomes.4,8,9
- Exploring and reinforcing the sustainability of virtual healthcare and its overall impact on both clinicians and patients.1
Practitioner-level strategies
- Increasing health professional familiarity with technical aspects of using videoconferencing platforms, including viewing imaging and pathology electronically.4
- Providing information and training for health professionals on the importance of protecting patient privacy in virtual settings, and the management of security (e.g. using secure, end-to-end encrypted platforms for videoconferencing).10
- Providing guidance for health professionals on how to effectively run, and participate in, virtual MDT meetings (including MDTs with a mixture of in-person and virtual attendance) to support effective engagement and appropriate videoconferencing etiquette.4
- Educating health professionals to improve adherence to multidisciplinary care guidance.3
Patient-level strategies
- Evaluating the extent to which a virtual MDT affects patient outcomes in comparison to a traditional face-to-face MDT, with particular reference to Cancer Australia principles of multidisciplinary care.11
References
[1] Aseem R, Warren O, Mills S, et al. Adjusting to the COVID-19 pandemic: challenges and opportunities of frontline colorectal cancer teams in the UK. Int J Colorectal Dis. 2020;35(9):1783-5.
[2] Salari A, Shirkhoda M. COVID-19 pandemic & head and neck cancer patients management: The role of virtual multidisciplinary team meetings. Oral Oncol. 2020;105:104693. doi: 10.1016/j.oraloncology.2020.104693
[3] Dharmarajan H, Anderson JL, Kim S, et al. Transition to a virtual multidisciplinary tumor board during the COVID-19 pandemic: University of Pittsburgh experience. Head Neck. 2020;42(6):1310-6.
[4] National cancer expert or consumer participant, Cancer Australia COVID-19 Recovery and cancer roundtable. Meeting minutes unpublished. 30 July 2020.
[5] Heifetz LJ, Koppel AB, Kaime EM, et al. Addressing rural disparities in cancer care via telehealth. J Clin Oncol. 2020;38(15_suppl):e19090.
[6] Wosik J, Fudim M, Cameron B, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-62.
[7] Lamprell K, Arnolda G, Delaney GP, et al. The challenge of putting principles into practice: resource tensions and real-world constraints in multidisciplinary oncology team meetings. Asia Pac J Clin Oncol. 2019;15(4):199-207.
[8] Soukup T, Lamb BW, Morbi A, et al. A multicentre cross-sectional observational study of cancer multidisciplinary teams: analysis of team decision making. Cancer Med. 2020;9(19):7083-99.
[9] Victorian Department of Health and Human Services. Victorian cancer multidisciplinary team meeting quality framework. Melbourne, VIC: Victorian Department of Health and Human Services; 2019.
[10] Sidpra J, Chhabda S, Gaier C, et al. Virtual multidisciplinary team meetings in the age of COVID-19: an effective and pragmatic alternative. Quant Imaging Med Surg. 2020;10(6):1204-7.
[11] Cancer Australia. Principles of multidisciplinary care. Surry Hills, NSW: Cancer Australia; 2020 [cited 2020 Aug]. Available from: https://www.canceraustralia.gov.au/clinical-best-practice/multidisciplinary-care/all-about-multidisciplinary-care/principles-multidisciplinary-care.