Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project.

BACKGROUND: Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making. OBJECTIVE: This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM's results. METHODS: For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design. RESULTS: The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022. CONCLUSIONS: The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/29004.

Health Care Organizations' Interoperability during Multi-Organizational Disaster Management: A Scoping Review.

INTRODUCTION: Disaster management (DM) is becoming increasingly complex because of technological advancement and the multi-organization and international contexts. Effective interoperability and adequate collaboration in DM have the potential to spare the human life and to control the economic burden. For those reasons, it's becoming important to find a way for systems and organizations that exploit, at the same time, the technological interoperability and team's interoperability.This study aims to provide an overview of the multi-organizational problems and solutions reflecting on achieving interoperability in multi-organizational DM. METHODS: The article is structured as a scoping review based on the Joanna Briggs Institute's (JBI) methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used to report the results. The selected papers were assessed using the Critical Appraisal Skills Program (CASP) checklists to screen their methodological quality.The scoping review was conducted systematically searching the databases PubMed, Google Scholar, and Web of Science. The search algorithm was developed using the three key concepts "interoperability; multi-organizational; disaster medicine" translated into different possible search and Medical Subject Headings (MeSH) terms. Studies of all research design types were considered. DISCUSSION: The included literature is reporting experiences on interoperability and how it has been applied to health care systems and organizations interacting during a disaster event. Twelve articles were included. Specific problems and solutions were identified regarding the technological and personnel interoperability, such as ineffective integration, technical problems, lack of an interoperability language, and data filtering network. The suggested approach might involve a focus on both the technological as well the human and personnel interoperability with the aim to create a culture of interoperability through compatible technological solutions and joint trainings. CONCLUSIONS: This study identified two main approaches during disasters: technology versus personnel interoperability. The suggested approach is to develop a hybrid culture of interoperability through compatible technological solutions combined to joint and multi-disciplinary trainings to achieve the development of a common language.Further research will need a solution-focused approach on the culture and language of interoperability as thematic gathering training, socio-technical networks, and policies/procedural guidelines.

Exploring non-physician care professionals' roles in cancer multidisciplinary team meetings: A qualitative study.

The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.

Understanding the Complexity, Underlying Processes, and Influencing Factors for Optimal Multidisciplinary Teamwork in Hospital-Based Cancer Teams: A Systematic Integrative Review.

BACKGROUND: Multidisciplinary teamwork has become the standard in care for oncological patients and their treatment trajectory when comprehensive, holistic, and high-quality cancer care is needed. Working together from a variety of perspectives is difficult to achieve and has well-known pitfalls, such as miscommunication and poor coordination. OBJECTIVE: To describe and synthesize the factors influencing and the processes underlying optimal multidisciplinary teamwork. METHODS: An integrative review was conducted, guided by the framework of Whittemore and Knafl. The systematic search for literature published since 2010 in 3 databases (PubMed, Web of Science, and Scopus) yielded 49 articles. RESULTS: Eighty-eight percent of the included studies focus on multidisciplinary team meetings, rather than on the wider notion of multidisciplinary teamwork. We identified influencing factors on the basis of structural features of the team, hospital, and health system, as well as process features of multidisciplinary teamwork in multidisciplinary team meetings. CONCLUSION: To improve multidisciplinary teamwork, the focus needs to be on the process of collaboration throughout the cancer care trajectory of the patient. A more integrated, interdisciplinary approach should be aimed for to recognize the role and contribution of all disciplines involved. IMPLICATIONS: A cultural change is needed toward interdisciplinary practice in hospitals to reach partnership between all involved professionals as part of a participatory, collaborative, and coordinated approach.

How multidisciplinary are multidisciplinary team meetings in cancer care? An observational study in oncology departments in Flanders, Belgium.

BACKGROUND: In current cancer care, multidisciplinary team meetings (MDTMs) aim at uniting care professionals from different disciplines to decide upon the best possible treatment plan for the patients based on the available scientific evidence. In Belgium, the multidisciplinary approach is mandatory and formally regulated since 2003. Current research indicates that MDTMs are not always truly multidisciplinary, ie, with a mix of medical as well as paramedical disciplines, and that the medical profession (physicians and medical specialists) tends to dominate the interaction in MDTMs. To ensure that MDTMs can benefit from their diverse membership to achieve their full potential, significant attention should be devoted to the multidisciplinary character of these meetings. The aim of this study is to explore and describe the multidisciplinary character in MDTMs and how it is actually shaped in practice in different Flemish medical oncology departments. METHODS: For this study, we carried out an observational comparative case study. We studied 59 multidisciplinary team meetings at inpatient medical oncology departments in five different Belgian hospitals (academic as well as general) and explored multidisciplinarity and how it is actually shaped in practice. RESULTS: The study is unique in identifying and analyzing three distinct types of MDTMs. The analysis of the three types revealed an inconsistent and, at times, contradictory picture of multidisciplinary team meetings. The findings also align with previous studies arguing that MDTMs in oncology are typically driven by doctors, with limited input of nurses and other nonmedical staff in which decisions are argued on biomedical information and far less consideration of psychosocial aspects. CONCLUSION: The concept of a MDTM should not merely be a group of care professionals who work essentially independently and occasionally liaise with one another. Yet, this study has shown a worryingly low awareness of the true character of multidisciplinarity, particularly among medical disciplines.

Input of Psychosocial Information During Multidisciplinary Team Meetings at Medical Oncology Departments: Protocol for an Observational Study.

BACKGROUND: Multidisciplinary team meetings (MDTMs) have become standard practice in oncology and gained the status of the key decision-making forum for cancer patient management. The current literature provides evidence that MDTMs are achieving their intended objectives but there are also indications to question the positive impact of MDTMs in oncology settings. For cancer management to be patient-centered, it is crucial that medical information as well as psychosocial aspects-such as the patients' living situation, possible family problems, patients' mental state, and patients' perceptions and values or preferences towards treatment or care-are considered and discussed during MDTMs. Previous studies demonstrate that failure to account for patients' psychosocial information has a negative impact on the implementation of the treatment recommendations formulated during MDTMs. Few empirical studies have demonstrated the predominant role of physicians during MDTMs, leading to the phenomenon that medical information is shared almost exclusively at the expense of psychosocial information. However, more in-depth insight on the underlying reasons why MDTMs fail to take into account psychosocial information of cancer patients is needed. OBJECTIVE: This paper presents a research protocol for a cross-sectional observational study that will focus on exploring the barriers to considering psychosocial information during MDTMs at medical oncology departments. METHODS: This protocol encompasses a cross-sectional comparative case study of MDTMs at medical oncology departments in Flanders, Belgium. MDTMs from various oncology subspecialties at inpatient medical oncology departments in multiple hospitals (academic as well as general hospitals) are compared. The observations focus on the "multidisciplinary oncology consultation" (MOC), a formally regulated and financed type of MDTM in Belgian oncology since 2003. Data are collected through nonparticipant observations of MOC-meetings. Observational data are supplemented with semi-structured individual interviews with members of the MOC-meetings. RESULTS: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology departments. Results of this study will particularly focus on the input of psychosocial information during MDTMs. CONCLUSIONS: The concept of an MDTM should not merely be a group of care professionals who mostly work independently and occasionally liaise with one another. Interventions aiming to enhance the input of psychosocial information are crucial to ensure that MDTMs can benefit from their diverse membership to achieve their full potential. The findings from this study can be used to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.