![]()
Resources
Organisation: |
National Breast and Ovarian Cancer Centre (NBOCC) |
Comments: |
pdf (105kb) Practical information about claiming the MBS item for multidisciplinary care introduced in 2006. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
Organisation: |
National Health Service (UK) Cancer Services Collaborative Improvement Partnership |
Comments: |
The purpose of this Multidisciplinary Team Resource Guide is to provide some practical advice to be used by clinical teams who are setting up or already running an MDT meeting. The Guide puts forward 12 questions based upon the requirements of the Manual of Cancer Standards and offers as answers some examples of service improvement case studies, resources and possible options to be considered. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
UK |
URL: |
Organisation: |
NHS Modernisation Agency |
Comments: |
pdf (301kb) Guide for improving communication between clinicians in cancer care. Contains a pro-forma template for communications within a multidisciplinary team. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
Organisation: |
Cancer and Palliative Care, Department of Human Services,Victoria |
Comments: |
pdf (264kb). This toolkit was written to assist the development of multidisciplinary teams in all tumour streams. The documents included in this toolkit are not intended to be prescriptive, but rather to prompt thought about the elements of best practice in multidisciplinary care. The toolkit will assist in: developing team meeting protocols and establishing team practice; surveying existing meetings and ascertaining what might be necessary for newly forming teams; understanding how local multidisciplinary team meeting guidelines and protocols might appear and what they could contain; measuring the team’s performance against the guidelines and protocols and developing or improving a multidisciplinary meeting agenda. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.health.vic.gov.au/cancer/docs/ics/meet_toolkit.pdf |
Team |
CanNET WA team, Albany Hospital, Albany and Great Southern Region, WA |
Focus of Meetings |
Focus is on the top five cancers - breast, lung, colorectal, urology, melanoma. However, patients with other cancers are also discussed. |
Attendees |
|
Meeting Chair |
General physician |
Meeting Coordinator |
Currently the project coordinator for CanNET, but with plans to recruit a multidisciplinary team coordinator |
Meeting Frequency and Duration |
Meetings are held fortnightly on a Wednesday at 7.30am, maximum 1 hour duration, but often less. Established in January 2008 |
Patients Discussed |
The team aims to discuss every newly diagnosed patient. Additionally, the team also puts forwards patients they are particularly concerned about or they feel would benefit from additional specialist advice from Perth. |
Issue |
To make sure that local cancer patients (in Albany, WA, a regional centre) have access to a locally-based coordinated care process, a multidisciplinary care review by oncology specialists, timely referrals and the right referral pathways. |
Solution |
Bring together key clinicians for regular multidisciplinary case discussions, with involvement and support from additional specialists based in Perth (participating via videoconference). The meeting agenda is prepared by the meeting coordinator in advance of the meeting using information provided by participating clinicians. Records about all patients discussed are kept in an Excel spreadsheet, and all required patient information, images and other documentation is stored on a shared electronic drive that can only be accessed by members of the team. The meeting coordinator sets up the meeting room, attends meetings, take notes and prepares management plans that are entered into the Excel spreadsheet, the patient's notes and are sent to the patient's GP. For particularly complex cases, the specialists based in Perth take the cases to their own Perth-based multidisciplinary team meetings for discussion. |
Benefits |
|
Barriers |
|
Enablers |
|
Future Plans |
|
Relevance For Others |
The following can be made available to other teams:
|
Other factors to consider |
In hindsight, the first thing to focus on when bringing together a new team is the team itself. For example, hold a team workshop to enable team members to get to know each other personally before they start working together as a team. |
Team |
Breast Team, North Coast Cancer Institute, Coffs Harbour, NSW |
Focus of Meetings |
Breast cancer |
Attendees |
Attendees are represented from both public and private services:
|
Meeting Chair |
Genetic counsellor |
Meeting Coordinators |
Multidisciplinary team coordinator (0.2 FTE), with support from the breast care nurses. Role currently filled by a non-clinical administrator and shared across four multidisciplinary teams in the Institute. |
Meeting Frequency and Duration |
1 hour weekly meetings held 1.00pm Wednesday, first established in 1999. |
Patients Discussed |
All breast cancer patients having surgery: all are discussed pre-surgery and post-surgery. Other team members may also request discussion of patients during later treatment stages. Ten or more patients may be discussed in each meeting. |
Issue |
Involvement of general practitioners (GPs) in multidisciplinary team meetings is desirable but notoriously challenging. This case study demonstrates the benefits of personal relationships to encourage participation, and the problems of sustainability with this approach. |
Solution |
In the early days of the meetings, coordination of the meetings was a core role of the breast care nurse. In order to facilitate involvement of GPs in the meetings, the breast care nurse personally contacted each relevant GP by phone several days in advance to invite them to attend. Attendance was possible in person or by teleconference. Irrespective of a GP’s involvement in the meeting, every GP is provided with an outcome letter on the same day as the meeting. The Institute uses an electronic medical record database to collate key information, images and results. During each meeting, the meeting coordinator records the key points for discussion and recommended treatment plan directly into the database. The information can be viewed on screen by meeting participants for final approval and a summary can be generated and faxed promptly to referring general practitioners. |
Benefits |
The personal invitation approach was successful in eliciting participation of 1–2 GPs on average, with a record of 6 GPs attending on one occasion. Key benefits of GP participation in the meetings include:
|
Barriers |
Resource limitations:
|
Enablers |
|
Future Plans |
Options being considered for future strategies include:
|
Relevance For Others |
|
Team |
Lung cancer multidisciplinary team, Sir Charles Gairdner Hospital, Perth |
Focus of Meetings |
Lung cancer (including mesothelioma, small cell lung cancer, non-small cell lung cancer). |
Attendees |
Core Membership:
|
Meeting Chair |
Respiratory physician |
Meeting Coordinators |
Lung Cancer Coordinator (Respiratory clinical nurse) - meetings coordinated by senior registrars in absence of Lung Cancer Coordinator. |
Meeting Frequency and Duration |
Weekly meetings of 1.5 hours |
Patients Discussed |
All newly diagnosed patients are discussed pre- and post-operatively for determination of a treatment plan and for post-operative staging. Approximately 6-18 patients discussed per meeting. |
Issue |
How to streamline tracking of patients within multidisciplinary meetings. |
Solution |
Development of an online database linking radiology and pathology The database is housed on the hospital intranet and the supporting software was developed by a web programmer with close supervision from the Lung Cancer Coordinator and Meeting chair. Diagnostic and staging information is entered in advance of the multidisciplinary meeting by senior registrars or the Lung Cancer Coordinator to ensure that a full patient history is available during the meeting. Use of the database is password protected and the software tracks who has entered information. The Lung Cancer Coordinator tracks patients from the point of referral to diagnosis and post-surgery and liaises with relevant members of the team to ensure that:
Data are projected onto a screen during the meeting together with pathology and radiology results. The lung cancer coordinator enters treatment recommendations and notes during the meeting as a record of what has been agreed. The software also incorporates a resource page with links to prognostic tools and clinical trials information that can be referred to during the meeting if required. A print out of the treatment plan is included in the patient’s file. |
Benefits |
|
Barriers |
|
Enablers |
|
Future Plans |
|
Relevance For Others |
Likely to be a valuable approach for other teams, especially those managing complex cancers with large numbers of patients. |
Other factors to consider |
Importance of patients having one point of contact within the team (in this case the Lung Cancer Coordinator) to help them navigate the system. |
Team |
Western and Central Melbourne Integrated Cancer Service (WCMICS), VIC, working collaboratively with: St Vincent's Hospital, Melbourne Health, Peter MacCallum Cancer Centre, The Royal Women's Hospital, Western Health and Werribee Mercy Hospital |
Focus of Meetings |
Separate meetings for breast cancer, colorectal cancer, haematology, upper gastrointestinal cancer, genitourinary cancer and central nervous system cancer. Separate meetings for most of these tumour streams are held in each of five tertiary hospitals within WCMICS. This case study outlines an audit process undertaken by WCMICS of 21 team meetings held in five hospitals across these six tumour streams. |
Attendees |
Attendance varies for each of the 21 meetings. The audit used the core membership recommended in the Victorian Department of Human Services Patient Management Frameworks as a gold standard. |
Meeting Chairs |
The Chair varies for each of the 21 meetings. In 13 meetings the Chair is the head of the relevant surgical unit. In most of the remaining 8 meetings, the Chair is the registrar or fellow from the relevant surgical unit. |
Meeting Coordinators |
The meeting coordinator varies between hospitals and between tumour streams. Most frequently (in 8 meetings) the surgical registrar is the coordinator, sometimes with assistance from a nurse coordinator or administrative staff. In the other meetings the meeting coordinator role is fulfilled by a range of staff including breast care nurses and surgical fellows. In general, meeting coordinators are responsible for compiling meeting agendas, obtaining required medical and psychosocial information such as external radiology, and documenting meeting recommendations. |
Meeting Frequency and Duration |
Varies across the 21 meetings: 76% are held weekly, 14% are held fortnightly and 10% are held monthly. The length of meetings ranges from 30 minutes to one hour. |
Patients Discussed |
Varies across the 21 meetings. The range includes:
Time constraints influence whether or not all new cases are discussed. Some teams have acknowledged that they think they need to discuss more cases than they do currently. Prior to the audit and ensuing changes, less than one-quarter of the meetings had developed written protocols specifying criteria for inclusion of patients for discussion. |
Issue |
Anecdotally it had been reported that the multidisciplinary team meetings across the Integrated Cancer Service needed to be improved, particularly in relation to documentation. Information about current processes was needed before undertaking any quality improvement activities. |
Solution |
A total of 21 multidisciplinary care meetings were audited across six tumour streams in five tertiary hospitals:
|
Benefits |
The audit identified several issues that are common across many or all of the meetings. These include:
Changes implemented as a result of the audit have already achieved a number of benefits.
|
Barriers |
|
Enablers |
|
Future Plans |
|
Relevance For Others |
|
Other Factors to Consider |
|
| Team | Breast, Gastrointestinal and Urology teams, Sydney Adventist Hospital Private Hospital |
| Focus of Meetings | Separate meetings for breast cancer, gastrointestinal cancer and prostate cancer. |
| Attendees | Surgery (specialist focus dependent on meeting), Medical Oncology, Radiation Oncology, Palliative Medicine, Pathology, Radiology Nuclear Medicine (Breast team), Plastic Surgery (Breast team), Nursing, Social Work, Psychology, Administration |
| Meeting Chair | Surgeon (specialist focus dependent on meeting) |
| Meeting Coordinators | Multidisciplinary Team Coordinator - the role is currently filled by a Registered Nurse and shared across all three teams. |
| Meeting Frequency and Duration | Fortnightly morning meetings for each cancer stream at 7.00am of 1 hour duration. Three teams means that one week involves one meeting; second week involves two meetings. |
| Patients Discussed | Selection of patients for discussion depends on team:
|
| Issue | How to standardise and coordinate the process of communicating information into and out of multidisciplinary meetings. |
| Solution | Development of templates and proformas:
|
| Benefits |
|
| Barriers |
|
| Enablers |
|
| Future Plans |
|
| Relevance For Others | Forms and templates can be made available to other teams. |
| Other Factors to Consider | Systems and processes become more streamlined with time. |
Team |
Head and Neck Cancer Multidisciplinary Team, Royal Brisbane and Women's Hospital, QLD |
Focus of Meetings |
Head and neck cancer (includes public and private patients) |
Attendees |
Core Membership:
Associate Membership:
A record of meeting attendance is kept by the MDT coordinator. A separate fortnightly Pathology meeting is coordinated by an ENT registrar. |
Meeting Chairs |
Dr Robert Hodge, ENT surgeon and in his absence a proxy. |
Meeting Coordinators |
Multidisciplinary Team Coordinator (Administration Officer) |
Meeting Frequency and Duration |
Weekly clinic and meeting:
|
Patients Discussed |
The aim is for all newly diagnosed patients to be seen and considered by the team. 12 new patients are admitted to the clinic each week (dictated by available space in clinic); these include:
Multidisciplinary meeting discussion includes these patients in addition to other relevant patients who may be undergoing treatment but require further discussion (up to 20 discussions per meeting) are mentioned. Cases are typically presented by the Ear, Nose and Throat. Plastic and Reconstruction Surgery or Maxillo-Facial registrars and Radiation Oncology registrars. |
Issue |
How to combine the multidisciplinary clinic and meeting effectively. |
Solution |
Clinic preparation:
Patient information brochure:
Meeting agenda:
Meeting documentation:
Data management system:
|
Benefits |
|
Barriers |
|
Enablers |
|
Future Plans |
|
Relevance For Others |
Team |
Barwon South Western Regional Integrated Cancer Service (BSWRICS), VIC: breast, colorectal, urology, lymphoma and lung teams based at Barwon Health. |
Focus of Meetings |
Separate meetings for breast cancer, colorectal cancer, urology cancer, lymphoma and lung cancer. |
Attendees |
Surgery, Medical oncology (consultants, registrars and residents), Radiation oncology (consultants, registrars and residents), Pathology, Radiology, Specialist nursing, Clinical trials coordination, General practice liaison (breast, colorectal, urology, and recruiting for lung and lymphoma), Physiotherapy (breast), Students (medical, nursing and pathology), Meeting coordinator and administrator, Patients own general practitioner when possible. |
Meeting Chairs |
Medical oncologist (urology, lymphoma, lung); Radiation oncologist (breast); Surgeon (colorectal) |
Meeting Coordinators |
Multidisciplinary Care Coordinator. Additional administration support in relation to generating weekly MDT communication, creating agendas, group online radiology images, coordinate pathology requests from external sites, data entry pre and post meeting, and allocating clinicians login. |
Meeting Frequency and Duration |
Differs for each stream:
|
Patients Discussed |
Participating clinicians select patients who would benefit most from a multidisciplinary discussion. The number of patients discussed differs for each stream, ranging from 4 patients in the urology meeting to up to 7 patients in the colorectal meetings. |
Issue |
How to streamline tracking of patients and documentation of discussions in multidisciplinary meetings. How to improve communication with teams and to provide facilities for interactive, remote participation in the meetings. |
Solution |
Development of an online database and communication system BiteIt developed the database software (CANMAP) for the Albury-Wodonga Border Cancer Collaboration Project. The database has been further developed to meet BSWRICS requirements. Key functions and roles of the online database and communication system are described below: Before multidisciplinary meetings:
Administrators check to ensure all images and other required documentation are available for the meetings. Radiology images are now available online via PACS systems or on CD's from providers outside the Geelong region. Radiologists and pathologists are provided with the opportunity to review images/results prior to the meeting. Radiologists can log in to review images (where the imaging provider offers this service), or they are provided with portable hard drives containing images relevant to each meeting. The hard drives can also be used during the meeting to reduce time spent waiting for images to upload to the website. During multidisciplinary meetings:
After multidisciplinary meetings:
Facilitation of remote participation via streamlined videoconferencing Videoconferencing participation has recently been taken to new levels in order to enable a haematologist (based in Warrnambool) to participate remotely in the lymphoma multidisciplinary team meetings (held in Geelong Hospital). Previously BSWRICS has used videoconferencing for education forums to link together staff caring for cancer patients to receive updates and new information about cancer care and treatments. This knowledge was built on to pilot videoconferencing of regional clinicians into Geelong meetings. The facilitation of remote access to the meeting required sourcing a room in Warrnambool for the specialist clinician and his team to use to videoconference into the meeting. In Geelong the videoconferencing facilities are available in the conference room the multidisciplinary meetings are held in. Fortunately the region is connected through the South West Alliance of Rural Health (SWARH) network, enabling videoconferencing to other SWARH sites at no cost. Prior to the first videoconferencing meeting, a practice link up was undertaken to check that participants in Warrnambool could see the pathology slides and radiology images presented in Geelong. The ability to see the pathology and radiology images at the far site depends on the bandwidth of the videoconferencing link. Participants based in Geelong were informed about the etiquette of video conferencing before the first videoconferencing meeting was held. The videoconferencing has improved the relationship between the clinicians in the geographically separate sites; it has facilitated streamlined care for patients with a haematological cancer in the region and has provided learning opportunities for the meeting attendees. Following the piloting of videoconferencing in one meeting, there are plans to implement it into the other meetings. Options for setting up videoconferencing facilities in the regional clinicians’ rooms are also being investigated, so they can link into the meetings without having to travel to the hospital (as currently happens). |
Benefits |
Online database and communication system
Streamlined videoconferencing
|
Barriers |
Online database and communication system
Streamlined videoconferencing
|
Enablers |
Online database and communication system
Streamlined videoconferencing
|
Future Plans |
Online database and communication system
Streamlined videoconferencing
|
Relevance For Others |
|
Other Factors to Consider |
|
Organisation: |
Cancer and Palliative Care, Department of Human Services,Victoria |
Comments: |
pdf (468kb). This guide provides information on the implementation of multidisciplinary care. Contents include: key principles of multidisciplinary care, what is practically required to implement multidisciplinary care and what are the medico-legal implications of multidisciplinary care in an Australian context. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.health.vic.gov.au/cancer/docs/mdcare/multidisciplinarypolicy0702.pdf |
Organisation: |
National Breast and Ovarian Cancer Centre (NBOCC) |
Comments: |
pdf (1.94mb) A report that outlines the medico-legal implications of multidisciplinary care in an Australian setting. The recommendations are based on a workshop of national experts conducted by the NBOCC. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.nbocc.org.au/health-professionals/clinical-best-practice/multidisciplinary-care |
Organisation: |
National Breast and Ovarian Cancer Centre (NBOCC) |
Comments: |
pdf (282kb). 2006 Report based on forums conducted nationwide in regards to the implementation of multidisciplinary care. Provides insight into the barriers to implementation of a multidisciplinary approach to cancer management in Australia and also demonstrates a range of creative models being used to implement a team approach to cancer care across a range of service settings. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.nbocc.org.au/download-document/mdr-making-multidisciplinary-cancer-care-a-reality |
Organisation: |
National Breast and Ovarian Cancer Centre (NBOCC) |
Comments: |
pdf (3.4mb) Final report of a 3-year National Demonstration Project on the definition, benefits and implementation of multidisciplinary care in Australia. |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.nbocc.org.au/resources/documents/MDC_multidisciplinaryproject.pdf |
Organisation: |
National Breast and Ovarian Cancer Centre (NBOCC) |
Comments: |
pdf (445kb). Follow up study to the National Demonstration Project in breast cancer |
Format: |
Website - information |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.nbocc.org.au/download-document/mss-sustainability-of-multidisciplinary-cancer-care-mdc |
Organisation: |
Medical Journal of Australia |
Comments: |
For women with early breast cancer, multidisciplinary care has the potential to reduce mortality, improve quality of life and reduce healthcare costs. In Australia, the diversity of healthcare delivery settings and types of care means that a single model of multidisciplinary care may not be appropriate. The "Principles of multidisciplinary care" were developed to provide a flexible framework for the provision of multidisciplinary care in Australia. The Principles emphasise five key elements: the team, communication, access to the full range of therapies, standards of care and involvement of the woman. This flexible, principle-based approach to multidisciplinary care is unique. The Principles have the potential to be applied to other cancers and other chronic diseases. |
Format: |
Journal article |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.mja.com.au/public/issues/179_10_171103/zor10160_fm.html |
Organisation: |
Clinical Oncological Society of Australia (COSA) and The Cancer Council Australia |
Comments: |
Outlines a plan to improve cancer treatment outcomes for rural and remote patients through the establishment of a network of regional cancer centres of excellence (RCCEs) in order to:
|
Format: |
Web based PDF report |
Target audience: |
Multidisciplinary |
Accessibility: |
Publicly available - no restrictions |
Cost: |
Free of charge |
Country of Origin: |
Australia |
URL: |
http://www.cosa.org.au/File/Reports/RegionalCancerCentreofExcellencedocument.pdf |

