The development of evidence based guidelines on the conduct of multidisciplinary cancer meetings (MDMs). A modified Delphi study. (#763)
Background: Australian guidelines on the conduct of multidisciplinary cancer meetings (MDMs) are largely based on expert opinion. We developed evidence based guidelines on the conduct of MDMs based on a literature review and results of a questionnaire survey administered to health professionals and patients across 5 Victorian centres. A Delphi study was performed to validate and refine these guidelines and ensure they are nationally relevant.
Methods: Opinion leaders in the fields of cancer care, health policy and ethics were invited to join an expert panel. Two consecutive multiple choice and short answer questionnaires pertaining to each guideline were administered according to Delphi methodology. A summary of the evidence relevant to each guideline accompanied the questionnaire. Consensus regarding agreement was defined a priori as 75% of respondents scoring >= 7 (using a 9-point likert scale) and disagreement being a score in 75% of =<3.
Results: 23 experts agreed to participate, 19 responses were received in round 1 (83% response rate). Results from round 2 will be available at the time of presentation. The panel reached consensus on the following proposed guidelines: 1)Discussion at MDM should result in an individualised, evidence based treatment plan agreed to by consensus. 2)Where divergent views or equivalent treatments exist, each option should be discussed with the patient. 3)The treatment plan should be documented in the medical record using a proforma and disseminated to treating clinicians outside the institution. 4)Documentation should be detailed enough for a clinician who did not attend the MDM, to be able to discuss and institute the treatment plan. After round one, consensus has not been achieved surrounding 1)the role of MDMs in addressing the supportive care needs of patients,2) the need for patient consent and 3)patient attendance at MDM.
Conclusions: These are the first Australian guidelines based on empirical evidence informing the conduct of MDMs. Innovative strategies to improve documentation and dissemination of the MDM treatment plan are needed as are novel methods of incorporating the supportive care needs of patients into the MDM plan.