Article Text

Protocol
Changing from face-to-face to virtual meetings due to the COVID-19 pandemic: protocol for a mixed-methods study exploring the impact on cancer multidisciplinary team (MDT) meetings
  1. Daisy McInnerney1,
  2. Donna Chung2,
  3. Muntzer Mughal3,
  4. Anjola Onifade4,
  5. David Holden3,
  6. Jacob Goodman5,
  7. Martin Birchall3,
  8. Michael D Peake3,
  9. Samantha L Quaife1
  1. 1Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
  2. 2Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3University College London, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4Imperial College London, Imperial College Healthcare NHS TrusT, London, UK
  5. 5North East London Cancer Alliance, North East London CCG, London, UK
  1. Correspondence to Dr Daisy McInnerney; d.mcinnerney{at}qmul.ac.uk

Abstract

Introduction In the UK, the National Cancer Plan (2000) requires every cancer patient’s care to be reviewed by a multidisciplinary team (MDT). Since the introduction of these guidelines, MDTs have faced escalating demands with increasing numbers and complexity of cases. The COVID-19 pandemic has presented MDTs with the challenge of running MDT meetings virtually rather than face-to-face.

This study aims to explore how the change from face-to-face to virtual MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of decision-making in cancer MDT meetings and to make recommendations to improve future cancer MDT working based on the findings.

Methods and analysis A mixed-methods study with three parallel phases:

  1. Semistructured remote qualitative interviews with ≤40 cancer MDT members.

  2. A national cross-sectional online survey of cancer MDT members in England, using a validated questionnaire with both multiple-choice and free-text questions.

  3. Live observations of ≥6 virtual/hybrid cancer MDT meetings at four NHS Trusts.

Participants will be recruited from Cancer Alliances in England. Data collection tools have been developed in consultation with stakeholders, based on a conceptual framework devised from decision-making models and MDT guidelines. Quantitative data will be summarised descriptively, and χ2 tests run to explore associations. Qualitative data will be analysed using applied thematic analysis. Using a convergent design, mixed-methods data will be triangulated guided by the conceptual framework.

The study has been approved by NHS Research Ethics Committee (London—Hampstead) (22/HRA/0177). The results will be shared through peer-reviewed journals and academic conferences. A report summarising key findings will be used to develop a resource pack for MDTs to translate learnings from this study into improved effectiveness of virtual MDT meetings.

The study has been registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/D2NHW).

  • COVID-19
  • ONCOLOGY
  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT
  • Telemedicine
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Strengths and limitations of this study

  • The protocol has been designed collaboratively and study conduct is being overseen by a multidisciplinary group of research psychologists, health service researchers and managers, cancer multidisciplinary team (MDT) members and a patient representative.

  • The conceptual framework guiding the mixed-methods data collection and analysis procedures was developed by synthesising models of group decision-making with existing MDT best-practice guidelines.

  • The novel questionnaire developed for the national survey has undergone a construct validity and prioritisation exercise with an expert group of psychologists and cancer MDT members.

  • The study is taking place during a time of ongoing change in methods of care delivery, related to the evolving COVID-19 restrictions that may restrict generalisability of the findings outside of this context.

  • The cross-sectional design will not capture any changes in opinion or group decision-making effectiveness over time nor allow inference of causality.

Introduction

Input from several healthcare professionals from different specialities, together with good communication with and involvement of patients, is fundamental to the delivery of gold standard cancer care. In 1995, the Calman-Hine report advocated for radical reform of cancer services in the UK, including equality of access to specialists.1 This informed the National Cancer Plan’s (2000) subsequent mandate that every patient’s care should be reviewed by a multidisciplinary team (MDT).2 MDT meetings were introduced to facilitate this specialist input and in doing so, reduce variation in access to, and decisions about, cancer care. However, since their introduction, MDT meetings have faced ever-increasing demands, in terms of the number of cases they review, the complexity of patient needs and growing diversity in available treatment options.3 This workload and time commitment must be managed alongside demanding clinical and professional roles, requiring additional capacity and attentional focus from the individual; a chair skilled in engaging all participants to achieve consensus; and adequate organisation, preparation, and notice.

In response to this increasingly demanding cancer care environment, the Cancer Vanguard reviewed MDT working across North East London (NEL) and North Central London (NCL). Their MDT Improvement Report (2017)4 concluded that improvements in infrastructure, streamlining processes, leadership and chairing are urgently needed. Subsequently, NHS England has set out guidance for streamlining MDT diagnostic and treatment decision-making during face-to-face meetings.5 This aimed to help ensure enough time is devoted to patients with more complex needs, to allow MDTs to be managed more flexibly to ensure specialists’ time is used effectively and to improve the transparency of decision-making about cancer care across Cancer Alliances. Indeed, a recent cross-sectional observational study of cancer MDTs6 conceptualised task difficulty (eg, complexity of the case), internal group factors (eg, size and composition) and external circumstances (eg, workload, multiple treatment options) as functional factors that interact to determine the quality of group decision-making.

More recently, the COVID-19 pandemic has presented MDTs with a new challenge, forcing MDT meetings and decision-making to take place virtually rather than face-to-face. This has potential advantages and disadvantages. For example, virtual MDTs eliminate geographical barriers and promote clinical communication and decision-making in diagnosis.7 However, there is concern over the difficulties associated with connectivity and technology of virtual MDTs. Reduced engagement and concentration may also occur as it is common for team members not directly participating in the discussion to mute or remove video images to minimise ‘digital noise’ and save bandwidth.8 This could negatively affect quoracy in decision-making and team dynamics for interacting and contributing to discussions if turn-taking is not effectively chaired. Indeed, eye contact and some of the non-verbal immediacy behaviours that invite and encourage contributions, pick up on confusion or difficulties, signal agreement or add emphasis may be largely absent or difficult to convey in virtual settings with medium to large groups. In one study of head and neck cancer MDT members (n=97), two-thirds agreed that team working was adversely impacted by the move to virtual working, with some MDT team members stating they were unable to adequately reinforce a point.9

Before the onset of the pandemic, some MDTs were already using technology to facilitate virtual or hybrid meetings.10 However, this was by no means universal, and the majority ran their meetings in a face-to-face format.10 11 The pandemic accelerated near-universal adoption of virtual meetings during periods of national lockdown, and many cancer MDTs are either continuing with virtual meetings or implementing more flexible hybrid meeting models (eg, meetings held face-to-face, with the option to join virtually as well), following the lifting of legal restrictions in place to limit transmission. Much existing research on MDT meeting effectiveness focuses specifically on virtual or face-to-face formats, but evidence suggests hybrid meeting formats in healthcare also have a distinct set of advantages and disadvantages.12

The existing evidence-base exploring the effectiveness of virtual and hybrid cancer MDT meetings has to date been limited to case studies and reflective reviews10 13–16; single-site studies11 17–19 and specific cancer specialisms9 12 14 or does not directly examine the impact of the transition to these meeting formats on the effectiveness of cancer MDT decision-making.7 20 21 By capturing cancer MDT experiences across the UK using a multisite mixed-methods design informed by behavioural science, this study will provide unique, translational insights into the effectiveness of the group decision-making process in virtual and hybrid cancer MDT meetings. The findings will be used to coproduce a pragmatic resource pack with MDT members and patient representatives. The pack will combine the study findings, and reference the NHS England MDT streamlining guidance,5 to inform best-practice in cancer MDT decision-making and facilitate service improvement. In doing so, these findings ultimately have the potential to improve cancer care for patients and the MDT working environment for healthcare professionals.

Objectives

Primary objective

  • To explore how the change from face-to-face to virtual and hybrid MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of group decision-making in cancer MDT meetings.

Secondary objectives

  • To explore cancer MDT members’ experiences of changing to, and participating in, virtual and hybrid MDT meetings.

  • To identify aspects of MDT meeting preparation, governance and engagement introduced by the change to virtual and hybrid hosting, that improve either the experience or perceived effectiveness of group decision-making.

Methods and analysis

Study design

A mixed-methods study splits into three stages: interviews, a national cross-sectional online survey and live MDT meeting observations.

We have developed a preliminary conceptual framework (table 1) informed by Soukup’s factors important for the quality of decision-making in cancer MDT meetings6; Forsyth’s Orientation-Discussion-Decision-Implementation (ODDI) group decision-making model22; National Cancer Action Team’s report on the characteristics of an effective MDT23 and NHS England’s (2020) MDT meeting streamlining guidelines.5

Table 1

Preliminary conceptual framework guiding data collection and analysis

We used the framework to inform the design of the data collection tools, ensuring each construct is appropriately measured by at least one of the studies, while reducing redundancy (table 2).

Table 2

Mapping conceptual framework constructs to data collection tools for each study

Sample

Population

Participants will be members of specialist and local cancer MDTs in England who have experience of taking part in virtual and/or hybrid cancer MDT meetings during the COVID-19 pandemic. The following definitions were used to guide MDT eligibility, adapted from existing conceptualisations of virtual and hybrid MDT meetings10:

  • Virtual MDT meetings are meetings where all members attend the meeting virtually (ie, no face-to-face meeting).

  • Face-to-face MDT meetings are meetings where all members attend the meeting face-to-face.

  • Hybrid MDT meetings are meetings conducted with some members attending face-to-face and others joining virtually.

Eligibility criteria

To be eligible for inclusion in this research, participants must meet all the following criteria:

  • Able and willing to give informed consent (as an individual or on behalf of the MDT).

  • Aged >18 years.

  • Member, co-ordinator or lead of a cancer MDT in England.

Individuals will be excluded from the study if they meet any of the following criteria:

  • Unwilling or unable to give consent (as an individual or on behalf of the MDT).

  • Unable to understand written and/or verbal English.

Sample size

Interviews

Up to 40 participants will be recruited for semistructured qualitative interviews, in line with norms for qualitative research24 and depending on data saturation (the point when no new themes are being interpreted from the data).25 This number has also been chosen to ensure that the sample is representative of factors likely to affect participants’ skillset and experience of virtual MDT meetings, including MDT role/membership, discipline and demographics.

Questionnaire

Cancer Alliance leads across England will be invited to distribute the questionnaire to their membership lists, but to be conservative, our sample size is based on the NEL and NCL cancer alliances.

With approximately 200 MDTs across these networks and an anticipated 50% responsiveness, we expect to be able to invite the members of 100 MDTs to complete the questionnaire. Each MDT will have at least five members (range 5–25 across local and specialist MDTs). Factoring in a conservative 38% questionnaire response rate from MDT leads in a previous report,4 we anticipate achieving a minimum sample of 190 respondents. With 190 participants, if 50% report a specific outcome, the expected 95% CI on this would be 42%–58%. For 70%, the 95% CI would be expected to be 63%–77%. For 90%, the 95% CI would be expected to be 85%–95%. Therefore, 190 would confer acceptable precision of estimation, though we expect to achieve a larger sample.

Observation

A minimum of six virtual or hybrid MDT meetings will be observed, including specialist (eg, urology, gynaecology, head & neck) and local (eg, breast, colorectal, upper gastrointestinal) MDTs. This is a resource intensive, in-depth method of study to collect exploratory data. The diversity of observed meetings is the most critical consideration for determining the sample, to ensure it is representative of a diverse multidisciplinary workforce across different MDTs.

Recruitment

With agreement from respective Cancer Alliance leads, NHS Trust cancer leads or personnel within the Alliance will be asked to email the questionnaire and interview invitations and study information to existing cancer MDT membership distribution lists. These personnel will be asked to provide the research team with the total number of invitations sent, in order to estimate response rates.

While we plan to invite MDT members from within NEL and NCL Cancer Alliances specifically, we also hope to involve other alliances in different regions across England in the interview and questionnaire study using the same processes. The invitation emails will include contact details for the research team, along with an instruction to contact them if they have any questions or would like to discuss anything about the study.

For the observation phase, our NHS coinvestigators will identify and invite leads or co-ordinators of eligible MDTs to take part.

Recruitment is planned to take place between April and July 2022.

Patient and public involvement (PPI)

Our patient representative member of our study management group (SMG) has reviewed the study design, methods and data collection tools. They have coauthored this manuscript (DH) and will remain involved throughout the study duration and be invited to be involved in activities to disseminate this work. A PPI consultation activity is also being undertaken to seek a more diverse range of perspectives, with a specific focus on understanding the acceptability of observing MDT meetings without requesting patient consent.

Study procedures

Interviews

An information sheet and consent form will be included with the initial approach email, along with a link to an online ‘eligibility and entry characteristics form’, to be completed by potential participants on the Online Surveys platform.26 This will collect contact details and the information needed to confirm eligibility and purposively sample to ensure diversity with respect to professional role/membership, specialist/local, cancer type and demographics. A sampling matrix will be used to monitor and track the balance of characteristics recruited within the sample, against which any new potential participant will be compared to determine whether they are recruited. Potential participants will have to check a box to confirm they give their consent for their data to be processed and stored for this purpose.

Participants will be contacted by the research team if they are eligible to participate in the interview study to arrange a time for the interview. Informed consent will be obtained prior to any participant being interviewed. This will include a discussion between the potential participant and the researcher about the nature and objectives of the research, their rights as a research participant (eg, to withdraw without giving a reason), the possible risks associated with their participation and the opportunity to ask any questions. Any individual deemed to be incapable of providing informed consent will be excluded. Verbal consent will be taken and audio-recorded using a consent form. To achieve this, each participant will be asked to state their name and today’s date. The researcher will read aloud each of the statements on the consent form and ask the participant to state whether they agree with each statement.

One-to-one, semistructured qualitative interviews will be carried out by research fellows remotely by telephone or Microsoft Teams. An interview topic guide has been developed, drawing on prior studies of MDT effectiveness4 27 in collaboration with patient representatives, clinicians and psychologists (see online supplemental file 1). The topic guide is structured to align with the conceptual framework (table 1) exploring participants’ experiences of virtual/hybrid MDT meetings, with a focus on interaction processes (with questions informed by constructs within the Team Climate Inventory28; individual and social factors) and the orientation, discussion and decision-making processes (informed by the ODDI model22). Questions will be open ended to allow participant-led discussion and insight. However, prompts will be used to ensure coverage of factors previously found to be important for decision quality and MDT interaction as well as those specific to virtual and hybrid MDT meeting attendance. The researcher conducting the interviews will also conduct the MDT observations in parallel (see the Observations section). Therefore, their experience and insights from these observations will inform their interview approach, within the bounds of ethical approvals for the interview topic guide.

With participants’ consent, the interviews will be audio-recorded using an encrypted digital audio recording device and transcribed verbatim.

Questionnaire

A link to the electronic questionnaire, hosted on the secure platform ‘Online Surveys’,26 will be included in the email invitation. Information about the study and participants’ rights will be presented on the first screen of this electronic questionnaire platform, with participants asked to complete an online informed consent form, which will be required before participants can progress to complete the questionnaire. Email addresses will be collected to enable the research team to identify duplicate responses during data cleaning and to send participants the results of the study (if they indicate that they would like to receive them). The survey will be open for 3 months. Reminder emails will be sent at weeks 3, 9 and 12.

Questionnaire development and validation

The questionnaire will measure aspects of virtual MDT preparation, governance, engagement and experience to identify the advantages and disadvantages of virtual versus face-to-face hosting (online supplemental file 2). It was developed from a preliminary question pool (n=87) based on the questionnaire used in the London Cancer MDT Improvement Report,4 early research evidence for virtual MDT meetings7 11 and the conceptual framework guiding the study (table 1).

A validation exercise was undertaken with a group of nine stakeholders (MDT members and behavioural scientists) to refine the questionnaire content from within this preliminary question pool. Questions in the initial pool were grouped into categories (The Team; Organisation and Logistics; Infrastructure; Governance and Decision-making) aligned to the guiding conceptual framework (table 1). Stakeholders rated the Priority, Appropriateness and Clarity of each item on a 5-point scale. A mean Priority, Clarity and Appropriateness score was then generated for each item and summarised with a composite overall score across each rating domain. Based on these ratings, and in discussion with the SMG, the research team refined the question pool to include the items ranked as highest priority and appropriateness as well as to ensure that each construct was adequately captured. Questions were also reworded to improve clarity as needed. The refined questionnaire was cross-checked with the observation proforma and interview topic guide to eliminate redundant items. The questionnaire will be informally piloted by up to 10 MDT members, and any amendments made before opening the questionnaire. Pilot responses to the questionnaire will not be included in the final analysis.

Observations

Single virtual meetings of specialist (eg, urology, gynaecology, head and neck) and local (eg, breast, colorectal, upper gastrointestinal) cancer MDT meetings will be observed. Once the invited MDT leads confirm their interest, following discussion with and agreement from the MDT lead, researchers will visit the MDT meeting to introduce and discuss the study and provide information sheets to each MDT member at least 2 weeks before the planned observation. Consent for the observation of the meeting will be given by the lead clinician on behalf of the MDT and audio-recorded using a verbal consent form.

Two observation proformas (1: ‘whole-meeting’ and 2: ‘case-by-case’) have been developed based on previous MDT research4 27 29 and emerging studies in virtual MDT meetings7 11 to ensure a standardised approach between observers and across meetings (online supplemental file 3). Informed by the conceptual framework (table 1), the proformas focus on capturing information relating to The Team (eg, attendees); External Circumstances (eg, organisation and logistics during the meeting and technical issues); changes in processes over the course of the meeting; and a ‘real-time’ quantitative measure of decision-making quality. This will be assessed using an adapted version of the MDT Metric of Decision-Making (MDT-Mode) tool, which assesses decision-making in MDTs through observation.29 Qualitative field notes will also be taken to record aspects of the MDT meeting, including team atmosphere, relative participation of different MDT members in the meeting, local context and case complexity. The proformas have been iteratively refined through training observations, in collaboration with our PPI representative and NHS coinvestigators.

To preserve the confidentiality of patient information disclosed during these meetings and ensure no patient data are inadvertently collected or retained in any way, the meetings will not be audio or visually recorded. Instead, the meetings will be observed live, by at least two members of the research team following training and practice observations to orientate and familiarise researchers with the proformas.

Outcomes and analysis

Study outcomes

Data from the three phases of the study will be triangulated to address the following outcomes:

Primary outcomes
  • Factors influencing the effectiveness of group decision-making in cancer MDT meetings (interpreted as themes from qualitative data and quantified with quantitative data).

Secondary outcomes
  • Cancer MDT members’ experiences of participating in virtual and hybrid MDT meetings.

  • Changes in MDT meeting preparation, governance and engagement which should inform service improvement.

Methods of analysis

Qualitative analysis

Thematic analysis will be carried out using QSR International NVivo V.11 software.30

Qualitative data from the interviews, free-text questionnaire questions and observation field notes will be collated and deductively coded to the constructs within the skeletal conceptual framework proposed in table 1 using applied thematic analysis.31 An inductive coding approach will also be used to allow this framework to be iteratively revised and to interpret unique themes within each construct. Initial coding will be carried out by one researcher with a subset of randomly selected transcripts independently coded to control bias. There will be multiple opportunities for team discussion, disagreement and iteration of the emerging coding framework.

Quantitative analysis

Quantitative responses from the observation and questionnaire will be summarised using IBM SPSS Statistics V.24.32 Descriptive analyses will be used to examine the frequency of each type of response, which will be presented as percentages in graphs and tables. Data from the questionnaire will be compared by type of MDT member using χ2 analysis (or logistic regression for adjusted analyses if a large enough sample size is achieved), to explore any associations between demographics, role, location and responses. A statistical analysis plan is provided in online supplemental file 4.

Triangulation

The cross-study findings from quantitative and qualitative components will be mapped to the constructs within the conceptual framework (table 1) to draw conclusions about how the transition to virtual and hybrid meetings has impacted the various inter-related aspects of group decision-making (eg, team composition, organisation and logistics, interaction processes, case complexity, repetition) that combine to determine the overall quality of decisions made in MDT meetings. The preliminary skeletal version of this framework is presented in table 1, but this will be iteratively refined based on study findings, where patterns emerge that suggest adaptation is needed. We will share the updated conceptual framework as an output of this work. In taking this approach, we aim to capture, integrate, compare and contrast the experiences of a range of cancer MDT types, which vary across many dimensions (eg, number and roles of attendees, cancer type, technological set up) to identify both general patterns of decision-making effectiveness in virtual and hybrid meetings as compared with face-to-face meetings as well as differences in effectiveness associated with differences in MDT characteristics. We will use these findings to make recommendations to facilitate effective, group-decision making in virtual and hybrid MDT meetings, making general recommendations that MDTs can use and adapt according to the specific needs of their team.

Data management

Data management plan

A detailed data management plan and Data Protection Impact Assessment have been developed and will be reviewed at regular intervals throughout the study in compliance with the UK Policy Framework for health and social care research, the Data Protection Legislation and Barts Health NHS Trust (Barts Health) and Queen Mary University of London (QMUL) Policies on the Retention and Disposal of Records (based on Department of Health recommendations on records retention).

Interviews

Separate recordings of the verbal consent and interview will be made using an encrypted digital audio-recording device. Following the interview, the audio recordings will be uploaded immediately to a secure folder within QMUL’s Data Safe Haven and deleted from the device.

The audio recordings will be transferred securely to a professional transcription service (‘The Transcription Agency’) using a secure file transfer mechanism and governed by a data sharing and processing agreement. Transcripts will be pseudonymised and stored in a password-protected file on the QMUL network drive for 5 years in compliance with QMUL’s record retention schedule. Audio recordings of verbal consent will be stored on the Safe Haven for a minimum period of 5 years. Audio recordings of the interview itself will be deleted after the transcriptions have been checked for accuracy by the researcher. During dissemination, quotes from interviews will be reported with limited demographic data to provide context to the quote (alliance, categorised job role and gender). More detailed demographics will only be reported in summary tables and not directly attributed to quotes to ensure anonymity of participants is protected.

Questionnaire

The Online Surveys platform being used to collect the questionnaire data is a secure, web-based application designed to support data capture for research studies and recommended by QMUL.26 Strict information security standards are followed (ISO27001) and all data are processed in compliance with UK General Data Protecton Regulation. Data can be exported directly into an SPSS file. Email addresses will be saved separately in a database on the secure QMUL Data Safe Haven once downloaded from Online Surveys and deduplication was completed. All other survey responses will be saved in an anonymised password-protected file on the secure QMUL network.

Observations

Meeting observation proformas will be completed electronically and saved in password-protected files on the secure QMUL network. No identifiable information will be recorded on the observation proformas. The data from these proformas will be entered directly onto an SPSS database (quantitative data) and Excel spreadsheet (qualitative data) stored in the secure QMUL network for analysis.

Ethics and dissemination

Approvals

The study is sponsored by the Joint Research Management Office (JMRO) for QMUL and Barts Health NHS Trust and has been approved by the Health Research Authority’s (HRA) and the London—Hampstead NHS Research Ethics Committee (REC) (04 April 2022; 22/HRA/0177).

The study conduct is being monitored by the SMG, including the CI, NHS collaborators, a patient representative and the study research team.

Consent

Participation in all aspects of this study is entirely voluntary, which will be emphasised in our recruitment approaches; all participants will be required to give their informed consent to take part. Patient information is not being used for research purposes but will be incidentally disclosed to the research team during their MDT meeting observations. It is not feasible to request consent from each patient; however, patients have the right to be notified about this and to have the opportunity to dissent. Notification of the research and avenue for dissent will be displayed (physically or digitally) within hospital outpatient waiting rooms at least 2 weeks prior to meeting observations taking place.

Confidentiality

The research has been approved by HRA Confidentiality Advisory Group (25 March 2022; 22/CAG/0048). Participants’ confidentiality will be protected by strict procedures for data collection and management. During the MDT meeting observations, researchers will hear information about patients being discussed. The live method of observation (rather than audio or visual recording) was chosen to ensure no patient information will be stored in any way. The observation proformas completed by researchers do not collect any patient information nor any personally identifiable information about MDT members. The researchers will be bound by the terms of confidentiality agreements between QMUL and each participating Trust to formalise this arrangement. Each researcher will also hold a Letter of Access for each participating Trust, binding them to ensure that all information regarding patients or staff remains secure and strictly confidential in compliance with the requirements of the NHS Confidentiality Code of Practice and the Data Protection Act 2018.

Dissemination

Anonymised quantitative data from the questionnaire will be uploaded to QMUL Open Access Data repository at the end of the study. Study results will be published in peer-reviewed journals and presented at academic conferences. A report summarising key findings will be prepared for the NCL Cancer Alliance and ‘Q Exchange’ and shared with participants should they request this. The results will be used to develop a resource pack for MDTs to directly translate evidence from this study into improved effectiveness of virtual and hybrid MDT meetings, funded by a grant from The Health Foundation’s ‘Q Exchange’ programme.

Ethics statements

Patient consent for publication

Acknowledgments

We are grateful to our site Principal Investigators (Chetan Bhan, Jen Fraser-Fish, Andrew Millar and Borzoueh Mohammadi) for supporting the set-up of this study; Stephen Duffy for his help with the sample size calculation for the survey phase; James Green for his advice and discussion on the methods for the observation phase of the study; and to the following for their invaluable help with the questionnaire validation and piloting exercise: Yogesh Bhatt, Stefanie Bonfield, Rachel Dodd, Helen Hall, Carolyn Horst, Suki Hothi, Evangelos Katsampouris, Andrew Millar, Borzoueh Mohammadi, Neal Navani, Paul Stimpson and Jo Waller.

References

Supplementary materials

Footnotes

  • Twitter @daisymcinnerney, @muntzer, @Anjola59537847, @QuaifeS

  • Contributors The study design was led by SQ, MM, DC and DM. SQ is the chief investigator. All authors (DM, DC, MM, AO, DH, JG, MB, MDP, SQ) made substantial contributions to the design of the study reported in this protocol through participation in study management group and/or dedicated planning meetings, and review of core study documents. SQ and DM wrote the first draft of the manuscript and all other authors (DC, MM, AO, DH, JG, MB, MDP) critically reviewed its intellectual content and approved the final draft. All authors agree to be accountable for ensuring questions related to the accuracy or integrity of any part of the protocol are appropriately investigated and resolved.

  • Funding This study is funded by a project grant from University College London NHS Hospital Trust, including all directed incurred costs and staff (grant number: N/A). The Chief Investigator’s time on this study is funded by a Barts Charity programme award (MRC&U0036). The development of the resource pack based on the findings of this research is funded by a grant from The Health FoundationThis study is funded by a project grant from University College London NHS Hospital Trust, including all directed incurred costs and staff (grant number: N/A). The Chief Investigator’s time on this study is funded by a Barts Charity programme award (MRC&U0036). The development of the resource pack based on the findings of this research is funded by a grant from The Health Foundation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.