Communication and Interaction in Multidisciplinary Tumor Conferences

Abstract

In some cancer centers in North Rhine-Westphalia, oncology patients are invited to participate in their case discussions in multidisciplinary tumor conferences (MTCs). Few studies have examined MTC communication with patient participation from the participant perspective, while an examination of specific aspects of communication is lacking. This work aims to generate insights into communication in MTC case discussions with patient participation and answer the following questions: 1) How do healthcare professionals (HCPs) assess opportunities and limitations of person-centered communication, specifically shared decision making (SDM) in MTCs with patient participation?; 2) How do patients communicate in MTCs with patient participation?; 3) How person-centered do HCPs communicate in MTCs with patient participation? Data for the three publications were collected between November 2018 and February 2020 at six breast and gynecologic cancer centers within the PINTU project (Patient involvement in multidisciplinary tumor conferences in breast cancer care). To answer the questions, different methods were used: (1) Conduct of semi-structured, guideline-based expert interviews followed by qualitative content analyses, and (2)/(3) survey data collection from patients and audio recordings of case discussions in MTCs with patient participation followed by analyses of patients', companions', and HCPs’ expressions in anonymized transcripts of audio recordings. Multiple regression analyses determined associations between communicative behavior, patient- and context-related characteristics, and patients' trust in the treatment team after case discussion. Results showed that (1) from the HCPs’ point of view, single steps of SDM can be implemented in a limited way in MTCs with patient participation; (2) patients and companions tend to express emotions indirectly; question number was significantly associated with the hospital, and patients’ need for psychological support led to a rise in questions asked; and (3) most questions of the HCPs were polar (yes/no). Patients' trust in the treatment team was associated with the nature of HCPs’ responses to emotions. Functions of MTC communication with patient participation could be analyzed; however, further research needs to address functions to fulfill and endpoints to achieve to use patients’ MTC participation effectively to actively engage patients in the MTC.