Individual and organizational determinants of patient participation in multidisciplinary tumor conferences

Abstract

<strong>Background:</strong> Patient participation in multidisciplinary tumor conferences (MTCpp) is a new healthcare reality. Initial knowledge exists concerning risks and benefits for patients and providers. It is also known that MTCpp rates differ between cancer centers, but no details are available on which patient groups participate. In this context, the theories and models of medical sociology and health services research help to explain individual and organizational determinants in healthcare and the provision of healthcare services. <br /> <strong>Aims:</strong> The aims of this cumulative dissertation are to analyze the use and determinants of MTCpp as well as to explore the provision of MTCpp. Thus, the four publications answer the following research questions: Which individual and organizational determinants of MTCpp can be explored? How do providers experience the feasibility and the provision of MTCpp? How do patients experience MTCpp? <br /> <strong>Methods:</strong> Within the four publications, data from three different research projects conducted in Germany between 2013 and 2020 is used. (1) The study protocol describes the methodological principles of the mixed-methods research on MTCpp followed here. In the three following original publications, (2) multilevel logistic regression analysis of survey data from 863 patients and 43 breast cancer centers, (3) content analysis of 30 provider interviews with inductive and deductive coding, (4) and descriptive analysis and content analysis of survey data from 8893 patients and 86 centers have been performed. <br /> <strong>Results: </strong>(1) After describing mixed-methods research on MTCpp, (2) the second publication revealed significant differences between patients participating in MTCs and between cancer centers themselves in MTCpp. (3) In the third publication, a mixed picture regarding providers’ experiences fostering or hindering the provision of MTCpp in the respective cancer centers was found. These results help explain differences between cancer centers in MTCpp that were analyzed in the second publication. (4) In the fourth publication, a wide range of patient experiences concerning decision-making, communication, and their emotional and cognitive situation during participation were found. These results help explain differences found in MTCpp between patient groups in the second publication. <br /> <strong>Discussion & conclusion:</strong> Using the throughput model, individual and organizational determinants for behavior, such as the use of MTCpp and the providers’ and patients’ experiences regarding the provision and use of the healthcare service MTCpp, were analyzed. Future research should focus on immediate, intermediate, and long-term outcomes by studying a wide range of psychosocial and medical outcomes of MTCpp. In terms of healthcare practice, an update of certification catalogs might be discussed if findings of an interventional phase-III study define risks and benefits associated with MTCpp.