Implementation of a lung cancer multidisciplinary team standardized template for reporting to genera

I’m reporting on the project
you see here on the screen. I’d just like to start by
acknowledging my collaborators on this project, and to point
out that I undertook this work while I was a research fellow at Sydney Catalyst Translational
Cancer Research Center, and the funding for the
project was provided by Cancer Australia’s Lung
Cancer Demonstration Project. The results of this project have also been recently published in BMJ
Open at the end of last year. So, I’m going to give you a
fairly brief overview today, but if you’d like to know more details, I’m happy to e-mail you a copy of the publication afterwards. So, this project ran over
about a 2 1/2 year project, sorry, 2 1/2 year period. Where we engaged with two lung cancer multidisciplinary teams in
local Sydney health district. We had a project officer working with us to start off by conducting
a needs assessment to look at areas where we might implement new simple interventions to try and answer some of the problems
around where there are real gaps or deficiencies in practice. And in consultation with
the multidisciplinary team and our consumer groups, we
had a group of three consumers. We identified that being
able to report the outcomes of MDT meetings to general practitioners was something that was
not happening as far as we knew, anywhere at all within
the local health district. As you can imagine most
general practitioners see less than one lung cancer patient per year. And frequently, when
that patient’s diagnosed the patient won’t have ongoing contact with that GP during their
active treatment time. For the GP then to provide
information or follow up care for that patient
can be quite challenging. If they’re pretty much in the dark about what’s happening with
that patients treatment. GPs also very rarely get to
participate in MDT meetings. So in another project that
we ran at Sydney Catalyst, we did an order of over 33 different MDTs and we actually found there was only one MDT who was regularly engaging with general practitioners as
a member of those meetings. So, today I just wanted
to focus on what we did and to really report
more on the qualitative rather than the quantitative results. Because the challenge
with this project was always going to be in our
pre implementation planning engagement strategy and making sure we had the clinicians on board. So, if you take on board
that probably the average patient case is discussed for
between seven and 10 minutes. There’s an enormous amount
of clinical information that the multidisciplinary team has to consider in that time. Looking at pathology slides, radiology, discussing the patients case. Any psychosocial or patient
circumstances as well as, then each of the contributing clinicians having to talk about
one of the recommended treatments for this patient, and then coming up with a consensus. So, what we found was a
key element to this project was being able to have a system where we could capture all of that information. Know what was going in to
the information that is collected before the MDT meeting actually takes place. Or the preparation before hand. So that we could prepopulate the form. And when I say we, I’m
talking about my project officer and the medical
and respiratory registrars who took on the responsibility for having to populate this information
during a meeting. So, an example of the template
is there on the screen. You can see it’s pretty
basic, straightforward. It’s giving a medical
history for the patient. It’s saying who’s engaged
in that MDT meeting, who are the clinicians that are present, what is the patients diagnoses, what is the recommended treatment and was their consensus
during the meeting. So, was there agreement? Because the GP is not
necessarily going to get a sense of whether there are any dissenting views. So, we had to take all of that information and in a very timely way,
in that seven to 10 minute timeframe be able to capture everything, enter new information, and
then take that template and within 48 hours we wanted
to send that to the GP. So, as you can see from
the results up there on the slide, over that 13 month period where we actually roll out the template we had 732 patients
presented over that time. And of those, we had 492
patients with a GP listed. So, we were able to
contact all of their GPs. Surprisingly, or perhaps not
to those of you in the audience who have done GP research,
98% of our GPs wanted that information faxed to them. So, we engaged the fax
machine in great earnest, sent these reports out
in a very timely way and then we followed up
with the GPs shortly after and asked them if they’d like
to evaluate the template. So, we had on average, less
than 10 minutes to speak to the GP on the phone and we asked them a set of six questions and
they reported over all, you can see there on the slide. 95% of them said this is fantastic, provided useful information
that was relevant. It was timely, it was easy
to interpret and it assisted in treatment planning and
communication with their patient. And I’ve just popped up
on the slide as well, a few examples of some of the qualitative comments that we got back from the GPs. So, in terms of implications,
I think this project really highlights that we can look at some simple short term solutions for communicating this
sort of information to GPs about what’s happening for
their lung cancer patient. It’s enabling us to think about what are the strategies
that we need to put in place to make sure that for the MDT
that the types of strategies that we can engage in are
something that the can incorporate into their work practice. We needed to heavily
engage with the information and technology team to make sure that they could do all the back end work of actually making this template integrate with the serna system that was in place. And if we hadn’t done all
of that preparatory work in the lead up to
sending out the templates it wouldn’t have allowed us then to see, that what we were evaluating
was actually something that would be sustainable
in the longer term. In terms of outcomes you
need to be able to transfer the knowledge collection and the process of sending out the
template away from having a paid Project Officer in
a short term research roll, to a task that the medical
and respiratory registrars can do as part of everyday practice. We think over the longer period we will be able to
sustain the inner two MDTs that have implemented the template. Following the end of this project, there was a lot of
interest from other MDTs within Sydney local health district. We sent out a expression of interest asking if they would like to go through a similar process and we’ve had uptake with now, seven different
MDTs adapting the template for their own use, in their practice. Thank you very much. (clapping) – [Announcer] Thank you very much, Nicole. Does anybody have any questions? – [Woman] Hello, (mumbles)
from Radiation Oncology. I’m just wondering in the templates can be pre populated from the
electronic medical record. – Yes, and that’s exactly what we did. So, we had as much
information as we could going into that template, so, that
then when the registrars were typing in the information,
they had the prepopulated plus the live information
going in at the same time. So, it’s a live process of doing that. Oh, I haven’t answered your question? Sorry. – [Woman] I had a question which was, obviously you’ve shown that this looks like it’s working really well in practice and going from the MDT to the GP. What information do you
have, or are you planning to get on the difference it’s
making to patient outcomes? – Well, if someone would
like to provide some funding for some follow up evaluation, we would be able to undertake that work. That wasn’t within the
scope of what we were doing but certainly it would be terrific now, to go back and assess
particularly the impact on whether the recommended
treatment at MDT was what went ahead, because
that’s not something that we could assess. So, whether the patient in consultation with their GP or with their specialist decided to go ahead with that treatment we haven’t been able to collect that data. So, it would be good to
look at the impact over time both the patient receiving more information and the GP as well. – [Woman] Very interesting, thank you.