ABSTRACT
AIM: The TELEMAM trial aimed to assess the clinical effectiveness and costs of telemedicine in conducting breast cancer multi-disciplinary meetings (MDTs). METHODS: Over 12 months 473 MDT patient discussions in two district general hospitals (DGHs) were cluster randomised (2:1) to the intervention of telemedicine linkage to breast specialists in a cancer centre or to the control group of 'in-person' meetings. Primary endpoints were clinical effectiveness and costs. Economic analysis was based on a cost-minimisation approach. RESULTS: Levels of agreement of MDT members on a scale from 1 to 5 were high and similar in both the telemedicine and standard meetings for decision sharing (4.04 versus 4.17), consensus (4.06 versus 4.20) and confidence in the decision (4.16 versus 4.07). The threshold at which the telemedicine meetings became cheaper than standard MDTs was approximately 40 meetings per year. CONCLUSION: Telemedicine delivered breast cancer multi-disciplinary meetings have similar clinical effectiveness to standard 'in-person' meetings.
Subject(s)
Breast Neoplasms/therapy , Decision Making , Telemedicine/statistics & numerical data , Attitude of Health Personnel , Breast Neoplasms/economics , Consumer Behavior , Costs and Cost Analysis , Female , Hospitals, District , Humans , Patient Care Team , Rural Health , Scotland , Telemedicine/economics , Treatment OutcomeABSTRACT
Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.
Subject(s)
Breast Neoplasms/therapy , Patient Care Team , Telemedicine/methods , Attitude of Health Personnel , Female , Humans , Interdisciplinary Communication , Scotland , Telepathology , Teleradiology , VideoconferencingABSTRACT
We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.
Subject(s)
Attitude of Health Personnel , Breast Neoplasms , Group Processes , Medical Oncology , Telemedicine/organization & administration , Analysis of Variance , Humans , Scotland , Surveys and Questionnaires , VideoconferencingABSTRACT
The purpose of this paper is to outline and discuss some of the fundamental theoretical and practical considerations bearing on the teaching of communications skills to nurses. Although evidence exists that communications training is needed, and welcomed by both nurses and nurse managers, implementation of training schemes without consideration of a number of critical issues is likely to result in only partial success, or even complete failure. The issues identified and discussed in this paper are the need for accurate assessment and evaluation, the need to understand and take into account resistance to change at the level of both the individual and the organization, and most pervasively, the need for a clear relationship between theory and practice.
Subject(s)
Communication , Nursing Staff/education , Health Services Administration , Humans , Models, Theoretical , Nurse Administrators , Nursing Theory , Organizational Objectives , United KingdomABSTRACT
This paper continues the debate opened by Will (1980), concerning the scientific status of psychoanalysis. A critique is made of Will's paper, on the grounds that it misrepresents the scientific method, and fails to consider appropriate criteria for evaluating psychoanalysis. A defence of Popper, and the importance of prediction as a tool in structuring understanding, is sketched out, and an alternative view of the scientific process which can more adequately encompass the enterprise of psychoanalysis is suggested.