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Barriers And Challenges Of Multidisciplinary Teams In Oncology Management: A Scoping Review Protocol
  1. Nicholas Lee Wei Law1,
  2. Lai Wei Hong2,
  3. Shirley Siang Ning Tan2,3,
  4. Chuan Jie Foo1,
  5. Daniel Lee1,
  6. Pei Jye Voon1
  1. 1Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
  2. 2Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
  3. 3Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
  1. Correspondence to Nicholas Lee Wei Law; nicholasllw77{at}gmail.com

Abstract

Introduction Multidisciplinary teams (MDTs) are integral to oncology management, involving specialised healthcare professionals who collaborate to develop individualised treatment plans for patients. However, as cancer care grows more complex, MDTs must continually adapt to better address patient needs. This scoping review will explore barriers and challenges MDTs have encountered in the past decade; and propose strategies for optimising their utilisation to overcome these obstacles and improve patient care.

Methods and analysis The scoping review will follow Arksey and O’Malley’s framework and begin with a literature search using keywords in electronic databases such as PubMed/MEDLINE, Scopus and PsychINFO, covering the period from January 2013 to December 2022 and limited to English language publications. Four independent reviewers will screen titles and abstracts based on predefined inclusion criteria, followed by full-text review of selected titles. Relevant references cited in the publications will also be examined. A Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram will be utilised to illustrate the methodology. Data from selected publications will be extracted, analysed, and categorised for further analysis.

Ethics and dissemination The results of the scoping review will provide a comprehensive overview of the barriers and challenges encountered by oncology MDTs over the past decade. These findings will contribute to the existing literature and provide insights into areas that require improvement in the functioning of MDTs in oncology management. The results will be disseminated through publication in a scientific journal, which will help to share the findings with the wider healthcare community and facilitate further research and discussion in this field.

Trial registration details The protocol for this scoping review is registered with Open Science Framework, available at DOI 10.17605/OSF.IO/R3Y8U.

  • ONCOLOGY
  • Systematic Review
  • Adult oncology
  • RADIOTHERAPY
  • CHEMOTHERAPY
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Strengths and limitations of this study

  • This scoping review will be the first to examine the challenges and barriers encountered by oncology multidisciplinary teams (MDTs) over the past decade.

  • This scoping review will provide an opportunity to assess the evolution of oncology MDTs and identify areas where approaches can be improved to better adapt to current demands.

  • This scoping review findings may not adequately reflect the overall barriers and challenges encountered in oncology MDTs in regions with limited resources, but merely as potential adaptation.

  • This review excludes grey literature sources such as theses and conference proceedings.

  • The review only includes published literature in English and does not feature any other languages in this review.

Introduction

Oncology care is defined broadly as cancer prevention, detection, and management. Over the last 25 years, the outlook of oncology management has changed drastically, especially with the advent of novel therapies and precision medicine. This is attributed to an enhanced comprehension of the molecular biology of cancer, coupled with advancements in methodology and analytical tools. These breakthroughs empower researchers to better unravel the molecular underpinnings of diseases and pinpoint potential molecular targets for intervention.1

Current oncology trends include therapeutics (precision medicine, immunotherapy, and targeted therapy),2–7 patient-centred care,8 multidisciplinary care,9 and technology in oncology care.10 Oncology and palliative care (PC) have traditionally been closely intertwined. However, over the past decade, paradigm-shifting randomised control trials have underscored the significance of integrating early PC with oncology care to enhance patient outcomes. While PC was once synonymous with end-of-life care for oncology patients, it has now evolved to be administered during the early stages of the disease trajectory, regardless of prognosis.11 These emerging trends in oncology management are designed to tackle the various factors that influence healthcare delivery for patients with cancer. The delivery of oncology management is a complex process that encompasses multiple aspects such as the patient’s clinical condition, availability of therapies, multidisciplinary management, support services, treatment costs, logistics, and patient education. Due to this complexity, it has become a common practice for healthcare professionals from diverse disciplines to come together and develop an individualised oncology treatment plan within the framework of comprehensive oncology management.

In the past, oncology management was often managed in isolated ‘silos’ by a single clinician, usually a surgeon or an oncologist. However, as our understanding of cancer has evolved with advancements in research and discoveries in oncology, we now recognise that cancer is a complex disease that requires a coordinated effort from multiple specialties. This realisation has formed the basis for multidisciplinary team (MDT) meetings, where healthcare professionals from various relevant specialties come together to share patient information and collaboratively decide on a comprehensive treatment plan.12 13

The MDT meeting is a well-established clinical practice within oncology, often incorporated across tumour boards and is recommended by cancer organisations, government bodies, and learnt societies as best practice for the last 25 years.14 15 In the past, MDT meetings in the USA were primarily practised to discuss rare and unusual cases for educational purposes. However, over the last 25 years, there has been a shift towards MDT meetings being practised for information sharing among healthcare professionals to improve patient care, and this convention has become more widespread.12 13 As our understanding of the pathogenesis of cancer and its treatment options has increased, the need for a multidisciplinary approach to oncology management has become more apparent. A clear historical example of this is the evolution of breast cancer treatment. Traditionally, mastectomy was the treatment of choice for decades. However, with the discovery of hormone receptors that differentiate hormone-dependent breast cancers from hormone-independent breast cancers, the use of radiotherapy, and the utility of adjuvant chemotherapy, the approach to breast cancer treatment has changed. It now requires collaboration among clinicians from different specialties, such as breast surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists, to provide a comprehensive treatment plan.12 This historical model has served as the foundation for other tumour streams, becoming the backbone of MDT meetings in oncology. Over time, it has evolved to include both clinicians from various medical specialties, and also allied health professionals, oncology nursing staff, administrative personnel (such as MDT coordinators), and other medical specialties that are relevant to the specific tumour stream.

An example of today’s evolution of MDTs is the development of metastatic spinal cord compression (MSCC) pathway; MSCC is an oncological emergency, which requires comprehensive multidisciplinary management to optimise effects on patients’ morbidity and quality of life. Clinical oncologists and neurosurgeons are integral to the neurosurgical pathway. Additionally, the establishment of an MSCC coordinator is essential to oversee diagnostic and treatment pathways. This coordinator plays a crucial role in providing training to junior doctors on the referral process and treatment pathway as part of their core teaching curriculum. Furthermore, to streamline the referral process, all referral forms are sent via email to the MSCC coordinator, who serves as the primary point of contact for relevant specialties.16

Since the widespread implementation of MDTs in oncology, numerous publications have assessed their impact on oncology care. Significant benefits of MDTs include improved patient outcomes, enhanced communication, and working relationships among healthcare professionals, increased opportunities for education, and better resource optimisation.9 17 18 More importantly, the widespread implementation of MDTs in oncology has visible improvement in outcomes such as overall survival, disease-free interval, and lower risk of recurrence.17 19–21 As MDTs become more prevalent in oncology care, they also bring to light the barriers and challenges that can hinder their effective implementation. Some of these challenges, such as time constraints, communication among MDT participants, patient selection, scope of implementation, and costs, have persisted since the routine implementation of oncology MDTs,22–25 and many of these publications have also acknowledged the difficulty in resolving these challenges, given the systemic nature of these shortfalls.26

Hence, identifying the barriers and challenges of MDTs is essential for enhancing collaboration, improving efficiency, overcoming professional silos, enhancing problem-solving, ensuring patient/client-cantered care, and fostering innovation. Therefore, this scoping review was initiated to examine the barriers and challenges encountered by oncology MDTs over the past decade, and to fill the evidence gap in our understanding of MDTs. By identifying the persistent challenges that hinder the effective implementation of MDTs and exploring potential solutions, this review will provide insights into how to adapt and optimise MDTs in our healthcare facilities, improving the quality of oncology management.

Materials and methods

The methodology of this scoping review is conducted following the methodological framework as drawn on from Arksey and O’Malley’s seminal framework27 for scoping reviews as the foundation and more recent advancements to the methodology.28 29 The framework included guidance on the following areas outlined in the sections below: identifying the research question, searching for relevant studies, selecting studies for inclusion, charting the data, and collating and summarising the report of the results.

Additionally, we referred to Chapter 11: Scoping Reviews of the JBI Reviewer’s Manual for guiding our development of the scoping review and its subsequent analysis of findings obtained28 since it provided a checklist that we can use to ensure that our scoping review would be developed and analysed according to an international standard. The JBI Reviewer’s Manual described in detail the entire process of planning, undertaking, and writing up a systematic review by using JBI methods, which was also designed to provide authors with a comprehensive guide to conducting JBI systematic reviews and chapter 11 of this manual focused specifically on scoping reviews.30

Identifying the research questions

The research questions for this scoping review are formulated to ensure a comprehensive coverage of evidence by having broad and well-defined inquiries. Two main research questions have been identified to guide the findings and subsequent discussion of this scoping review and they are as follows:

  1. What is the type, nature, and extent of research publications pertaining to barriers and challenges faced by MDTs in oncology management over the past decade globally?

  2. What are the existing identified barriers and challenges, along with their implications, relevant to the Malaysian healthcare setting?

While oncology MDTs have been implemented in various tumour boards, with some dating back to the late 1990s, numerous publications have depicted their implementation and the barriers and challenges encountered. However, for this review, the focus is on publications within the past 10 years that specifically address oncology MDTs and their barriers and challenges. This scoping review will enable the research team to assess the relevance of these barriers and challenges in light of the current clinical demands, and these identified barriers and challenges will be categorised for further discussion and analysis. In addition, 2013 signifies the success of cancer immunotherapy in clinical trials which marks a turning point in the treatment of cancer. It is worth noting that some of these obstacles are universal and recurrent themes seen in multiple papers and centres across continents, such as costs and logistics, collegiate factors, available information, and time pressure.

The research team acknowledges that the majority of published papers on this topic may be centred in the western hemisphere and reflective of their practice. However, it is anticipated that the barriers and challenges identified in these publications are likely to be experienced in developing nations as well, and may even be more significant compared with their counterparts in developed nations. In addition, it is essential to identify the relevant barriers and challenges in order to implement targeted improvements that can optimise existing resources and enhance clinical outcomes in oncology management.

The second research question aims to investigate if the barriers and challenges identified in the literature are applicable to the healthcare system in Malaysia, particularly in East Malaysia, where achieving equity in oncology management is an ongoing challenge for healthcare providers and patients. Oncology management in East Malaysia encounters unique challenges, including the need to consistently provide gold-standard clinical care while addressing systemic issues such as cost, logistics, and health awareness, in order to bridge the gap in health inequality. Therefore, the two research questions are in line with the objective of this scoping review, which is to systematically map and analyse the existing research on the barriers and challenges encountered by MDTs in oncology management over the decade, taking into consideration the current healthcare needs.

Identifying relevant studies

A comprehensive search will be conducted using electronic databases such as PubMed/MEDLINE, Scopus, and PsycINFO from January 2013 to December 2022. PubMed/MEDLINE and Scopus are chosen as primary search systems due to their extensive coverage of relevant literature related to oncology MDTs. PsycINFO, with its emphasis on the psychosocial aspect of oncology management, will be included as a unique topic database to ensure a comprehensive search strategy.

Search strategy and study selection

A systematic search will be conducted in PubMed/MEDLINE, Scopus, and PsycINFO using a combination of keywords as outlined in the online supplemental file. The search strategy was designed to identify all relevant studies related to MDTs and oncology, and the search terms were kept broad to capture the maximum number of eligible studies.31–33 No study design filter will be applied, allowing for the inclusion of various research methodologies such as systematic reviews, qualitative studies, quantitative studies, and case studies, while excluding conferences, erratum, books, chapters, or encyclopaedias. However, a language filter will be applied, to retrieve only studies published in English.

Mapping the data from each included study

Once all the search results have been retrieved from the electronic databases, a screening process will be conducted by a team of four researchers. The screening process will involve carefully reviewing the titles and abstracts of the retrieved studies, which will be tabulated using Microsoft Excel 2010 for Windows. Two authors will initially screen the titles and abstracts of all citations, and each study will be charted using a data extraction sheet. Subsequently, the another two independent reviewers will extract primary domain data from the included studies such as year of publication, title, aim of the study, study design, and findings. This ensures that all records are double-evaluated by independent reviewers to maintain the quality of the screening and reviewing process.27 29

The flow of information throughout the various phases, including record identification through databases, screening for duplicates, eligibility assessment, and the inclusion of relevant literature, will be visually represented in a flow chart (figure 1) following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The original flow diagram proposed by QUOROM (Quality of Reporting of Meta-analyses) will be modified to reflect the numbers of identified records, excluded publications, and included results. This flow chart will provide a clear overview of the entire process and help readers or reviewers understand the steps taken, as well as the limitations of the process.

Figure 1

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram. MDTs, multidisciplinary teams.

Charting the data

A data charting table will be utilised to systematically organise and tabulate relevant information from all the included studies in this scoping review. The table will capture various items such as type of publication, country, author(s), title, abstract, aim, study design, cancer type and staging, treatment, barriers and challenges, and outcomes. This table will serve as a tool to electronically record pertinent information from each study. The corresponding description for each item or information extracted will be listed in table 1.

Table 1

Indication for each item in the data extraction

Collating, Summarising, and reporting the results

This scoping review aims to provide an overview of the existing research on the topic of interest, rather than conducting an in-depth analysis of the quality of individual studies. Scoping reviews involve the synthesis and analysis of various types of research and non-research sources to gain a comprehensive understanding of a specific topic or field of evidence. Hence, to draw conclusions from the collected data, it is essential to identify and categorise several articles related to the topic of interest, treating them as a single unit of analysis. The results obtained from this narrative synthesis will be reported to describe the findings related to the barriers and challenges of MDTs in oncology care.

Ethics and dissemination

This scoping review protocol serves as an initial plan that outlines the overall strategy for conducting the scoping review before the actual review process begins, and includes a detailed and structured plan that outlines the objectives and methodology of the scoping review. The research team will carefully document any amendments made to the protocol during the review process. Once the review is complete, the full report of the findings will be submitted for publication in a scientific journal to disseminate the research findings to the broader scientific community.

This study is registered with the National Medical Research Register (NMRR) Malaysia, with registration number RSCH ID-23-00462 S3K. However, obtaining ethical clearance for this study is not required, as it is a scoping review that does not involve direct participation of human subjects, but rather involves reviewing and data collection from existing literature.

Ethics statements

Patient consent for publication

Acknowledgments

We would like to thank the Director-General of Health Malaysia for his permission to publish this article.

References

Footnotes

  • Contributors NLWL and LWH are responsible for the management and integrity of the design, conduct, and reporting of the research project. He is involved in the conception and design of the protocol; and ensuring the integrity of any collaborative relationships. He will also be involved in the planning, data collection, data analysis, and reporting of the work in this paper. SSNT is involved in the conception of the protocol. She will be involved in the data collection, data analysis, and reporting of the work in this paper. FCJ and DJ are involved in the conception of the protocol and will be involved in the data collection and data analysis in this scoping review. VPJ is involved in the conception of the protocol, responsible for project management, and serves as scientific advisor to the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • 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.