The Role of Comorbidity in Cancer Care Decision-Making in Multidisciplinary Teams — ASN Events

The Role of Comorbidity in Cancer Care Decision-Making in Multidisciplinary Teams (#128)

Louise Signal 1 , Kevin Dew 2 , Jeannine Stairmand 1 , Diana Sarfati 1 , Chris Cunningham 3
  1. University of Otago, Wellington South, New Zealand
  2. School of Social and Cultural Studies, Victoria University, Wellington, New Zealand
  3. Research Centre for Māori Health & Development, Massey University, Wellington, New Zealand

Aim: Multidisciplinary team meetings (MDMs) are increasingly the context within which cancer treatment decisions are made internationally.  Little is known about how comorbidity is considered, or impacts decisions, in MDMs. This study reports on a systematic literature review and observation of MDMs to assess the role of comorbidity in cancer care decision-making in multidisciplinary teams.

Methods: Eight original, heterogeneous studies of medium quality were included in the review. Ten MDMs (lung, breast, colorectal, upper gastrointestinal) discussing 115 patient cases were audiorecorded in two regional cancer treatment centres in New Zealand. Recordings were transcribed and analysed using the conventions of conversation analysis to identify how and what issues are ‘recognised’ and ‘attended to’ by the participants.

Results: Review results suggest that comorbidity is rarely explicitly considered in MDMs and, when it is, results in more conservative treatment, despite evidence that such treatment may be well tolerated and effective. In contrast, comorbidity was commonly discussed in the ten recorded MDMs. Considerable power for the treatment decision resided with the person who had ‘encountered’ the patient, usually their specialist. This ‘encountered authority’ particularly came into play when there were different treatment pathways being considered.

Conclusions: MDMs should systematically consider the comorbid status of patients in light of evidence of effectiveness of treatment for comorbid patients. They should also ensure that those with ‘encountered authority’ are aware of this evidence given their power in decision-making. Further research is needed to assist clinicians to undertake MDM decision-making that addresses comorbidity consistently and appropriately to optimize outcomes for cancer patients with comorbidities.