Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

OBJECTIVES: Given the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient. DESIGN: A sequential mixed-method study. SETTING: One oncology centre and its partner in the Northern part of the Netherlands. PARTICIPANTS: Head-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner. PRIMARY AND SECONDARY OUTCOME MEASURES: Percentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT. RESULTS: In eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fresh perspective by hearing the case 'as new'. The teams recognise the importance of keeping their medical viewpoints aligned, but the requirement (that the partner should discuss all patients) was seen as outdated. CONCLUSIONS: The added value of the video-conferenced MDT is small considering patient care, but the specialists recognised that it is important to keep their medical viewpoints aligned and that their patients benefit from the discussions on complex cases.

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