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Title: Socio-cognitive factors that affect decision-making in cancer multidisciplinary team meetings
Author: Soukup Ascencao, Tajana
ISNI:       0000 0004 9350 0839
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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Multidisciplinary team meetings (MDMs) are a mandatory part of the cancer care pathway in the UK. While they facilitate diverse disciplinary input into formulation of treatment recommendations, evidence of this approach is unclear with a common pattern of skewed inputs by senior physicians and biomedical aspects of the disease. The decision-making (DM) in MDMs is a highly intricate process, however. The team is exposed to an intense period of cognitive activity in a context that necessities them to process information and formulate decisions not only cognitively on an individual person basis, but also interactively between the team members, and in the face of multiple layers of complexity pertaining to the clinical elements of the disease, external circumstances, and those emanating from within the MDM itself. Adding to current body of knowledge, the thesis provides an original contribution to two very specific strands of research. On the one hand, the thesis provides evidence that intense and prolonged periods of cognitive activity, evident in cancer MDMs, lead to fatigue and deterioration not only in the quality of DM and chairing, but also in the quality of team interactions; and that the team’s cognitive resources can be replenished with evidence based strategies, such as for e.g., a rest break, and organisation of workload according to case-complexity. As such, the findings address a gap in the current literature, which is focused largely on the healthcare worker fatigue arising from excessive working hours and shift work. They also carry implications for cancer patient safety and quality of care planning. On the other hand, the thesis provides evidence that the quality of team interactions is closely linked to the team’s ability to reach a recommendation and to the DM process itself, with negative socio-emotional responses having an inhibitory effect on the MDT. Although superior to lone DM, the thesis reveals certain drawbacks for cancer teams; specifically, that securing one’s turn to speak is a challenging task, presenting as an additional cognitive burden, as MDMs are characterised by rapid turn transitions and a high level of interactivity with overlaps between speakers mainly competitive in nature. As the time-workload pressure increases, the quality of team DM processes is compromised with the most common interaction style being between two to three disciplines only, and the value of nursing input becomes particularly evident. Overall, the findings contribute to narrowing the gap in the MDT literature, to-date focused largely on evaluating team work from a macro-level perspective, and offer distinct directions for improving the flow of work through MDTs and addressing team fatigue.
Supervisor: Sevdalis, Nick ; Green, James ; Darzi, Ara Sponsor: National Institute for Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral