Socio-cognitive factors that affect decision-making in cancer multidisciplinary team meetings

Tajana Soukup Ascencao, Nick Sevdalis, James Green, Ara Darzi, National Institute For Health Research (Great Britain)
2020
Multidisciplinary team meetings (MDMs) are a mandatory part of the cancer care pathway in the UK. While they facilitate diverse disciplinary input into formulation of treatment recommendations, evidence of this approach is unclear with a common pattern of skewed inputs by senior physicians and biomedical aspects of the disease. The decision-making (DM) in MDMs is a highly intricate process, however. The team is exposed to an intense period of cognitive activity in a context that necessities
more » ... to process information and formulate decisions not only cognitively on an individual person basis, but also interactively between the team members, and in the face of multiple layers of complexity pertaining to the clinical elements of the disease, external circumstances, and those emanating from within the MDM itself. Adding to current body of knowledge, the thesis provides an original contribution to two very specific strands of research. On the one hand, the thesis provides evidence that intense and prolonged periods of cognitive activity, evident in cancer MDMs, lead to fatigue and deterioration not only in the quality of DM and chairing, but also in the quality of team interactions; and that the team's cognitive resources can be replenished with evidence based strategies, such as for e.g., a rest break, and organisation of workload according to case-complexity. As such, the findings address a gap in the current literature, which is focused largely on the healthcare worker fatigue arising from excessive working hours and shift work. They also carry implications for cancer patient safety and quality of care planning. On the other hand, the thesis provides evidence that the quality of team interactions is closely linked to the team's ability to reach a recommendation and to the DM process itself, with negative socio-emotional responses having an inhibitory effect on the MDT. Although superior to lone DM, the thesis reveals certain drawbacks for cancer teams; specifically, that securing one's turn to speak is a challengi [...]
doi:10.25560/79603 fatcat:qyn5paimlbbbfoedhrdccr3via