Wallace, IG; (2017) Multidisciplinary team meetings in cancer care: a qualitative study of the role of status hierarchies in the decision making process. Doctoral thesis , UCL (University College London).

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Abstract

BACKGROUND: Multidisciplinary teams (MDTs) are the established model for managing cancer care in England. Weekly MDT meetings bring together different healthcare professionals with diverse knowledge and expertise in order to facilitate patient-centred decision making. However, little consideration has been given to the role of status hierarchies in the decision making process in these teams. AIM: The aim of this PhD is to explore the way that status hierarchies between healthcare professionals unfold during the decision making process in cancer MDT meetings, and to identify factors that inhibit or facilitate multidisciplinary discussion. It also considers approaches used by lower status groups to contribute during meetings. METHODS: A qualitative study was undertaken of four MDTs: one gynaecology, one skin and two haematology cancer MDTs. This involved thematic analysis of data from non-participant observation of 122 MDT meetings and 26 semi-structured interviews with professionals and patients. FINDINGS: Higher status professionals (medical and surgical consultants) played a dominant role in all four cancer MDTs. Although lower status professionals (specialist nurses and junior doctors) contributed much less frequently, they were more likely to participate in complex cases, for example when patients had limited treatment options. Multidisciplinary discussion was influenced by team size, seating arrangements, the approach to presenting cases for discussion, and the behaviours of both higher and lower status individuals. Higher status individuals provided support for lower status contributions when they demonstrated inclusive leadership behaviours. In turn, lower status individuals contributed successfully by sharing information, asking questions, providing practical suggestions, framing contributions in medical or surgical terms, and using humour. These approaches prompted discussion, influenced treatment plans and facilitated teamwork. CONCLUSION: This study enhances understanding of the approaches that can be used by MDTs to capitalise on the relevant knowledge and skills of all team members when making decisions in the MDT meeting.

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