Virtual cancer MDT meetings during the COVID-19 pandemic
Research type
Research Study
Full title
Changing from face-to-face to virtual meetings during the COVID-19 pandemic: exploring the impact on cancer multi-disciplinary team (MDT) meetings
IRAS ID
307410
Contact name
Samantha Quaife
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
0 years, 10 months, 0 days
Research summary
Research Summary
Background and aims:
Multidisciplinary teams (MDT) are groups of professionals from one or more clinical discipline who together make decisions regarding recommended treatment of individual patients. In the UK, the National Cancer Plan (2000) requires every cancer patient’s care to be reviewed by an MDT. The aim is to facilitate specialist input and reduce variation in access to, and decisions about, cancer care. However, since the introduction of these guidelines, MDTs have faced increasing demands, in terms of the number and complexity of cases they review. Further guidelines have since been released to help improve and streamline MDT working. More recently, the COVID-19 pandemic has presented MDTs with the challenge of running MDT meetings virtually rather than face-to-face. This has potential advantages and disadvantages.
In this study, we aim to explore how the change from face-to-face to virtual MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of decision-making in cancer MDT meetings. And use the findings to co-produce resource packs to improve future cancer MDT working.Who?
We will invite members of cancer MDTs within Cancer Alliances who have taken part in virtual MDT meetings during the pandemic to participate in the study. This will include healthcare professionals of various roles, including consultants, surgeons, histopathologists and radiologists.How?
There are three phases of the study:
1. Interviews with up to 40 members of cancer MDTs (conducted by phone or virtual platform)
2. An online questionnaire sent to members of more than 200 cancer MDTs
3. Observation of at least 6 virtual cancer MDTs , with notes made by researchers on structured and approved proformas.The interviews and observations will be conducted with members of cancer MDTs working at sites within the North East and North Central Cancer Alliances. We will explore the possibility of distributing the questionnaire to Trusts across England.
Summary of Results
Background and aims:
In the UK, the National Cancer Plan (2000) requires every cancer patient’s care to be reviewed by a multidisciplinary team. A cancer multidisciplinary team is a group of doctors, nurses and other healthcare specialists who work together to diagnose and treat people with cancer. Cancer multi-disciplinary teams run meetings to decide what next steps in care they think would be best for each patient. After the meetings, they then discuss their recommendation with each patient. Traditionally cancer multi-disciplinary team meetings are run in-person (or “face-to-face”). However, improvements in video-technology mean some teams now run their meetings online (“virtually”), or with a mixture of people joining in-person and online via a video-call (“hybrid”). During the COVID-19 pandemic, nearly all cancer multi-disciplinary teams had to move to virtual meeting formats to slow down the spread of the virus. Today, many cancer multi-disciplinary teams continue to meet in virtual or hybrid formats.
This study explored whether there were any differences in how cancer multi-disciplinary teams made decisions in virtual and hybrid meetings, compared to in-person meetings. The researchers wanted to understand the challenges and opportunities for teams meeting in these online meeting formats. They aimed to use these findings to make recommendations to help cancer multi-disciplinary teams improve their decision-making in virtual and hybrid meetings. The study met these objectives.
Overview of methods:
There were three phases of this study, all carried out between May – October 2022:
1. An online questionnaire sent to cancer multi-disciplinary team members in England: the questionnaire asked team members details about what they thought worked well about virtual and hybrid meetings, and what worked less well.
2. Observations of cancer multi-disciplinary teams meeting in virtual and hybrid formats in London: researchers observed how the teams worked together to make decisions, any difficulties they faced, as well as what worked well.
3. Research interviews with cancer multi-disciplinary team members in England: members of the research team asked team members in more detail about their experiences participating in virtual and hybrid meetings, and what they think could be improved.Overview of results:
The research team are still working on analysing the results of the study. But they do have early findings to share from each phase of the study. They analysed the results of the observations and interviews together using a process called thematic analysis, so report the early findings together below. However, it is important to know that the results of the thematic analysis reported here are not final and may change as the analysis continues.
1. The survey of cancer multi-disciplinary team members:
a. Who took part?
Responses were received from 257 cancer multidisciplinary team members from across 18 Cancer Alliances (Cancer Alliances are regional networks responsible for over-seeing how NHS Trusts run their cancer services in their local area). Most participants were female (65%) and between 46 – 60 years old (58%). A range of different cancer types and roles were represented.
b. Key findings:
More cancer multi-disciplinary team meetings were running in virtual and hybrid formats when we ran the study (96%) compared to before the pandemic (45%). Most respondents (59%) preferred hybrid meeting formats to face-to-face or virtual meetings. But whilst about half of respondents (46%) felt that the quality of decisions made in virtual compared to face-to-face meetings was the same, 4/10 (41%) felt that decisions made in face-to-face meetings were better. These results show how important it is that teams work effectively in virtual and hybrid formats.
Most people reported that attendance was about the same (44%), or higher (38%) in virtual meetings. Most (88%) felt that they had the same amount of time to discuss each patient in virtual meetings compared to face to face meetings. But almost a quarter (24%) felt patients were discussed in less depth in virtual meetings.
Access to appropriate technology was reported as an issue. Ninety-eight percent of respondents reported that technology issues had negatively affected their participation in virtual meetings. The most frequently reported problems were issues with sound quality, logging on and quality of internet connection. People also reported feeling the team did not interact as well in virtual meetings compared to face-to-face.
2. The multi-disciplinary team meeting observations and interviews with members:
a. What meetings did we observe and who did we interview?
We observed 8 cancer multi-disciplinary teams being run virtually or in a hybrid format by cancer teams working in London. This included upper gastro-intestinal, gynaecology, urology, head and neck, lung, prostate and colorectal cancer teams. We also interviewed 30 cancer multi-disciplinary team members, from across the country working across a broad range of cancer types and with different roles including MDT leads (n=4), surgeons (n=4), consultants (n=5), nurses (n=6), radiologists (n=2), pathologists (n=3), trainees (n=1), speech and language therapists (n=1) and co-ordinators (n=4).
b. Key findings:
Using thematic analysis we grouped together the following main findings from the observation and interview studies:
1. The team: Virtual and hybrid meetings enable broader and more flexible meeting attendance with broader expertise. However, not everyone feels as able to participate in the meeting in virtual settings compared to face-to-face. Having an effective chair is key to making good decisions, but can be particularly challenging in virtual and hybrid meetings. There are limited opportunities for team-building in virtual and hybrid meetings, and the group dynamic may not be as open or sociable.
2. Organisation and logistics: Co-ordinators often have additional administrative tasks to take on in virtual and hybrid meetings which can be challenging. But the change is an opportunity to streamline processes by making the most of features of the technology (for example, Microsoft Teams channels). It is also important to state patient names and numbers before each discussion to prevent confusion, which is more common in virtual and hybrid meetings.
3. Meeting infrastructure: There is potential for more distractions in virtual and hybrid meetings. Having a quiet private space to join the meeting is therefore key. Inequalities in access to an appropriate space and/or equipment can also reinforce hierarchies between different staff members. Sound quality is a key issue that can lead to delays in decision-making and an unproductive team climate. Access to training and IT support is a key to enabling good decision-making in virtual and hybrid meetings.
4. Governance: It is critical for NHS Trusts to work with multi-disciplinary team leads to make sure appropriate infrastructure is in place to meet the teams’ needs for virtual and hybrid meetings.
5. Decision-making process: Joining meetings remotely allows team members to multi-task, but this can distract them and so they may not always pay full attention to the decision being made. In virtual and hybrid meetings, there is a lack of non-verbal cues (such as body-language). This disrupts the natural flow of discussion during decision-making. In hybrid meetings, discussions can be split between those in the room, and those joining online. Members are also more likely to talk over or interrupt each other in virtual and hybrid meetings. Although decisions are always reached, the decision is not always clearly communicated to all members in virtual or hybrid meetings.Safety and compliance to UK Policy Framework for Health and Social care research, GCP and the protocol: There were no adverse events, safety incidents or protocol/GCP deviations incurred as a result of this study.
Bringing the results together – what next?
Based on the findings, the research team are working with a group of experts to develop recommendations for cancer multi-disciplinary team members to help them run effective virtual and hybrid meetings. These guidelines will made available to all cancer multi-disciplinary team members in May 2023.
REC name
London - Hampstead Research Ethics Committee
REC reference
22/HRA/0177
Date of REC Opinion
15 Mar 2022
REC opinion
Further Information Favourable Opinion