Dr Tracy Robinson - Using a Multidisciplinary Program of Cancer Care as a Vehicle for Research Translation

2. Using a Multidisciplinary
Program
Of Cancer Care as a Vehicle for
Research Translation
Tracy Robinson (PhD; BA Hons; RN)

3. OUR TEAM
• Professor Paul Harnett - Director, Sydney West TCRC
• Ms Pamela Provan - Manager, Sydney West, TCRC
• Assoc Prof Tim Shaw - Director, WEDG, USyd
• Dr Tracy Robinson – Research Fellow (USyd & SW TCRC)
• Kylie Museth (Innovations Manager, SW TCRC)
• Ms Anna Janssen -Project Manager, (Usyd & SW TCRC)
• Dr. Karin Lyons - Research Support Officer (WM)
• Dr Jenny Shannon – Nepean Hospital
• Dr Peter Flynn – Nepean Hospital
• Dr Julie Howle – Westmead Hospital

4. Our Place
Sydney West Cancer Network
Comprehensive cancer services network treating
~4000 new cancer patients, over 130000
outpatients and 6000 inpatients annually.
Westmead Millennium Institute
Independent research institute with over 420
research staff attracting over $20 million in
research grant funding annually.

5. Sydney West
• MDT’s are primary vehicle for delivering cancer care
in Sydney West
• MDT meetings only one aspect of wider program in
cancer care (clinical networks, registrar training etc.)
• Significant investment of time and resources
• Important to define their composition, processes
(such as how they document and make decisions)
• Supported by establishment of the Sydney West
TCRC

6. MDTs as Vehicles for Translational
Research
• implementation science complex - involves
identifying type of knowledge, perceived relevance,
clinicians & the health care setting (Ebener et al.,
2006).
• What is the role of MDTs in implementation science
and translational research?
• variability in the performance of MDTs
• What is the type and extent of variation that is
acceptable or even desirable in MDTs? (Lamb et al.,
2011).

7. Implementation Science
Heath
informatics
clinical
epidemiology
evidence
synthesis
communication
theory
economics
public policy
behavior
science

8. What is the Evidence for MDT Care?
• Great variance in the approach and processes of
different MDT’s (Meagher, 2013)
• Look Hong, Wright, Gagliardi, et al., (2010) reviewed
21 studies on MDT care and cancer survival:
– No clear evidence that MDT care improves
survival
– Some evidence for improved clinician and patient
satisfaction

9. What is the Evidence for MDTs?
• Audits and surveys demonstrate:
– Reduced time to diagnosis and treatment
– Improved adherence to guidelines
– Improved inclusion in clinical trials
– Improved patient satisfaction
– Improved education and collegiality for clinicians
(Cancer Institute, NSW, 2010)

10. Draft Guidelines for MDTs in NSW
Broad domains for performance include:
– Team membership
– Team governance and organisation
– Best practice care
– Data collection and documentation
– Communication with GP
– Patient centred care
– Team Development and quality improvement
(Cancer Institute NSW, 2013)

11. Current Study
PHASE 1
observations
semi structured
interviews,
Priority Setting
Barrier &
Enabler Analysis
PHASE 2
Implementation
Interventions
PHASE 3
key research
performance
indicators /
metrics

12. Phase 1 Methods
• Observations (N=43) of several MDT tumor
streams:
– Lung
– UGIT
– LGIT
– Gynae Onc
– Breast
– Breast metastatic
– Urology
• Semi Structured Interviews (N=18)

13. Phase 1 Broad Findings
• Most MDTs use T2 research and some generate it
• Small number generate T1 research
• Very few MDTs active in T3 research or quality
improvement
• Awareness of T3 research is low
• The relationship of MDTs versus individual (s) in
research is unclear
• Not all disciplines appear equally research active

14. Gap Analysis
• Unclear role for MDTs in QI – no formal process for
identifying gaps/ improvement issues
• Lack of T3 leadership – most research clinical trials
• Access to integrated & longitudinal data challenging
• Coordination & support for MDT meetings varies
• Regularity and existence of business / research
meetings varies (no forum for fielding questions)
• Regular audit and feedback, e.g., treatment
responses not routine

15. Key Enabling Factors
• Academic leadership/ capacity in T3 research
• Integrated data
• Interprofessional collaboration / learning
• Regular business meetings
• Research fellows (T3)
• Processes for problem identification / QI
• Medical students

16. Conclusions
• A single method usually insufficient to cause change -
strategies need to be multi faceted (Grol, 2013).
• Formal processes for gap identification needed (QI
links and regular audit and feedback)
• Formal processes for data collection and integration
essential
• More interventions do not automatically lead to
greater success – how to ID key ingredients?
• Need to raise awareness of practice based research
methods

17. THANK YOU
Tracy.robinson@sydney.edu.au

18. REFERENCES
• Ebener, S.A., Khan, R., Shademani, L., Compernolle, M., Beltran. M., et al.,
(2006). Knowledge Mapping as a Technique to Support Knowledge
Translation. Bulletin of the World Health Organisation. 84(8):636-42.
• Grol, R., & Wensing, M. (2013). Principles of Implementation in Change, in
Grol, R., Wensing, M., Eccles, M. & Davis, D. (Eds). Improving Patient Care:
The Implementation of Change in Health Care (2nd Edition). John Wiley &
Sons.
• Lamb, B.W., Wong, H.W.L., Vincent, C., Green, J.S.A., Sevdalis, N. (2011).
Teamwork and team performance in multidisciplinary cancer teams:
Development and evaluation of an observational assessment tool. BMJ
Qual Safety, 20: 849-856.
• Lock Hong, NJ; Wright, FC; Gagliardi, AR; Paszat, LF (2010). Examining the
potential relationship between multidisciplinary cancer care and patient
survival: An international literature review. J. Surg. Oncol, 102 (125-34)
• Meagher, A.P. (2013). Colorectal cancer: are multidisciplinary team
meetings a waste of time? ANZ Journal of Surgery, 83 (101-108).