Centring the patient in a Multi-Disciplinary Team approach: a qualitative case study of team work and supportive relationships with breast cancer patients

Introduction, aims and objectives
• Multidisciplinary teams (MDTs) are increasingly at the forefront of cancer care provision in Australia with some evidence that they improve the experience and outcome of care delivery for patients.
• Further research is needed to explore how clinicians within MDTs support person-centred care for patients undergoing breast cancer treatment.1,2
• This study aimed to explore clinicians’ perspectives on MDTs, team work, and their relationships with patients with breast cancer.
• The objectives were to: a) describe clinicians’ views of their roles within the MDT; b) discuss clinicians’ outlook on their work relationships with other MDT members; and, c) assess clinicians’ interpretations of breast cancer patients’ relationships as they traversed treatment pathways.

Method
• In-depth interviews were conducted with four members of an MDT; a clinical psychologist (CP), a radiation therapist (RT), a medical oncologist (MO), and a breast surgeon (SO); between August 2016 and November 2016.
• This study was based in a private, not-for-profit, teaching hospital, located in New South Wales, Australia.
• The revelatory case study approach was used as a single-case that allowed access to descriptive details of MDT professionals’ working habits.
• The case-study was considered holistically, using a single unit of analysis to build a rich picture of individual practice within the unique context within which MDTs function.

Results
• Participants described their approach to practicing person-centred care as “effective communication” and “consistent information exchange”.
• MDT members suggested that these notions provided patients with reassurance, whilst enhancing understanding of patients’ values.
• Adapting to MDT styles and if necessary, changing communication strategies to support a more person-centric approach, was seen as valuable.
• Each individual clinician related to others in the professional team and to the patients being treated according to their own roles, responsibilities and disciplinary values (Figure 1).
• The medical oncologist and the surgeon tended to provide patients with clinical advice and guidance.
• Patients often drew on the support of allied healthcare professionals such as the clinical psychologist and radiation therapist to assist their decision-making, and cope with the intensity of cancer treatment.
• The clinical psychologist played a mediation role between the patient, the surgeon and the medical oncologist, to ensure patients’ values were reflected in treatment decisions.
• The radiation therapist would spend time personally contacting patients, to support their physical and psychological health during treatments.
• The aim of the MDT was to ensure patients remained at the centre of collaborative working practices, despite the fact that not all team members communicated directly with one another.

Conclusion
• Team-based and individual practices can vary by role, with each clinician operating according to work-based relationships that can influence patient care.
• Case study is an effective method for examining how practitioners interact with one another within a specific context, and how decisions are made, with the emphasis on the unique qualities of the case or ‘case conditions’.
• The results of the study will inform a larger, up-scaled study of MDT working practices in the context of breast cancer professional decision-making, and patients’ treatment experiences.