PDF(Pubmed)
Abstract：
UNASSIGNED: In cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying to maximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: \"Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70?\". This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings.
UNASSIGNED: This was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some principles of conversation analysis (qualitative).
UNASSIGNED: We found that, across teams, surgeons were the most frequent initiators and responders of interactional sequences, speaking on average 47% of the time during case discussions. Cancer nurse specialists and coordinators were the least frequent initiators, with the former speaking 4% of the time and the latter speaking 1% of the time. We also found that the meetings had high levels of interactivity, with an initiator-responder ratio of 1:1.63, meaning that for every sequence of interactions initiated, the initiator received more than a single response. Lastly, we found that verbal dysfluencies (laughter, interruptions, and incomplete sentences) were more common in the second half of meetings, where a 45% increase in their frequency was observed.
UNASSIGNED: Our findings highlight the importance of teamwork in planning MDT meetings, particularly with regard to Cancer Research UK in 2017 cognitive load/fatigue and decision-making, the hierarchy of clinical expertise, and the increased integration of patients\' psychosocial information into MDT discussion and their perspectives. Utilizing a micro-level methodology, we highlight identifiable patterns of interaction among participants in MDT meetings and how these can be used to inform the optimization of teamwork.
UNASSIGNED: This was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some principles of conversation analysis (qualitative).
UNASSIGNED: We found that, across teams, surgeons were the most frequent initiators and responders of interactional sequences, speaking on average 47% of the time during case discussions. Cancer nurse specialists and coordinators were the least frequent initiators, with the former speaking 4% of the time and the latter speaking 1% of the time. We also found that the meetings had high levels of interactivity, with an initiator-responder ratio of 1:1.63, meaning that for every sequence of interactions initiated, the initiator received more than a single response. Lastly, we found that verbal dysfluencies (laughter, interruptions, and incomplete sentences) were more common in the second half of meetings, where a 45% increase in their frequency was observed.
UNASSIGNED: Our findings highlight the importance of teamwork in planning MDT meetings, particularly with regard to Cancer Research UK in 2017 cognitive load/fatigue and decision-making, the hierarchy of clinical expertise, and the increased integration of patients\' psychosocial information into MDT discussion and their perspectives. Utilizing a micro-level methodology, we highlight identifiable patterns of interaction among participants in MDT meetings and how these can be used to inform the optimization of teamwork.
摘要：
■在癌症治疗中，多学科团队（MDT）会议是黄金标准。虽然他们试图在工作量稳步增加的情况下最大限度地提高生产力，癌症发病率不断上升，财政限制，和人员短缺，人们对团队产出的质量提出了担忧，正如英国癌症研究所在2017年报道的那样：“有时我们讨论多达70名患者。这是在一整天的诊所之后，我们直到19点之后才完成。你想成为70号吗？”本研究旨在系统地探讨MDT会议中小组互动和团队合作的一些动态。
■这是一项在英国三家MDT/大学医院进行的前瞻性观察性研究。我们每周录像30次会议，对822例患者进行了回顾。使用杰斐逊符号系统转录录音的横截面，并使用频率计数（定量）和一些对话分析原理（定性）进行分析。
■我们发现,跨团队,外科医生是互动序列最常见的发起者和响应者，在案件讨论期间，平均有47%的时间发言。癌症护士专家和协调员是最不频繁的发起人，前者讲4%的时间，后者讲1%的时间。我们还发现会议的互动性很高，发起者与响应者的比率为1:1.63，这意味着对于每个发起的交互序列，发起者收到的响应不止一个。最后,我们发现言语障碍(笑声，中断,和不完整的句子)在会议的后半部分更常见，观察到它们的频率增加了45%。
■我们的发现强调了团队合作在规划MDT会议中的重要性，特别是关于2017年英国癌症研究中心的认知负荷/疲劳和决策，临床专业知识的层次，以及越来越多的患者心理社会信息融入MDT讨论及其观点。利用微观层面的方法，我们重点介绍了MDT会议参与者之间可识别的互动模式，以及如何使用这些模式来优化团队合作。
■这是一项在英国三家MDT/大学医院进行的前瞻性观察性研究。我们每周录像30次会议，对822例患者进行了回顾。使用杰斐逊符号系统转录录音的横截面，并使用频率计数（定量）和一些对话分析原理（定性）进行分析。
■我们发现,跨团队,外科医生是互动序列最常见的发起者和响应者，在案件讨论期间，平均有47%的时间发言。癌症护士专家和协调员是最不频繁的发起人，前者讲4%的时间，后者讲1%的时间。我们还发现会议的互动性很高，发起者与响应者的比率为1:1.63，这意味着对于每个发起的交互序列，发起者收到的响应不止一个。最后,我们发现言语障碍(笑声，中断,和不完整的句子)在会议的后半部分更常见，观察到它们的频率增加了45%。
■我们的发现强调了团队合作在规划MDT会议中的重要性，特别是关于2017年英国癌症研究中心的认知负荷/疲劳和决策，临床专业知识的层次，以及越来越多的患者心理社会信息融入MDT讨论及其观点。利用微观层面的方法，我们重点介绍了MDT会议参与者之间可识别的互动模式，以及如何使用这些模式来优化团队合作。
