PDF(Pubmed)
Abstract：
In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.
摘要：
2020年1月，NHS英格兰和NHS改进，在英国,发布了简化癌症多学科（MDT）会议的宽松框架。简化定义为在MDT会议（MDM）中对复杂案例进行优先讨论的过程。而直接病例的管理是使用护理标准(SoC)加快的。SoC是患者管理途径中的要点，在该途径中，对管理方案有公认的指南和明确的临床共识，应在区域范围内达成共识并由区域癌症联盟统一应用。虽然本报告标志着自1995年Calman-Hine报告以来癌症MDT管理的首次重大变化，但其实施，全国,自出版以来，到现在已经慢了将近四年了。然而，有人认为，精简是确保MDT流程可行性的必要步骤，因此，在当前工作量和癌症发病率上升的社会经济背景下维持患者护理，财政压力,劳动力短缺。在这个迷你评论中，我们简要总结了围绕2020年精简框架实施的最新发展，包括其实施的挑战和障碍，以及这个领域未来的潜在方向，我们建议应该提高实施科学的利用率。我们得出的结论是，确保框架和SOC的成功实施需要获得关键利益相关者的支持，包括MDT和医院管理团队，具有明确定义的（a）管理方法，包括分诊（例如通过小型MDT会议），(B)评估案例复杂性(直接输入SOC的东西)，以及(c)MDT牵头人和成员的作用，同时承认，如果不考虑团队和医院信托基金之间的个体差异，SOC就无法普遍应用。
