Improving Decision Making in Multidisciplinary Tumor Boards: Prospective Longitudinal Evaluation of a Multicomponent Intervention for 1,421 Patients Benjamin W Lamb, MRCS, PhD, James SA Green, FRCS, Jonathan Benn, PhD, Katrina F Brown, PhD, Charles A Vincent, PhD, Nick Sevdalis, PhD BACKGROUND: Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to opti- mize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB’s ability to reach treatment decisions. STUDY DESIGN: We conducted a prospective longitudinal study during 16 months that evaluated MTB deci- sion making for urological cancer patients at a university hospital in London, UK. After a baseline period, MTB improvement interventions (eg, MTBs checklist, MTB team training, and written guidance) were delivered sequentially. Outcomes measures were the MTB’s ability to reach a decision, the quality of information presentation, and the quality of team- work (as assessed by trained assessors using a previously validated observational assessment tool). The efficacy of the intervention was evaluated using multivariate analyses. RESULTS: There were 1,421 patients studied between December 2009 and April 2, 2011. All outcomes improved considerably between baseline and intervention implementation: the MTB’s ability to reach a decision rose from 82.2% to 92.7%, quality of information presentation rose from 29.6% to 38.3%, and quality of teamwork rose from 37.8% to 43.0%. The MTB’s ability to reach a treatment decision was related to the quality of available information (r ¼ 0.298; p < 0.05) and quality of teamwork within the MTB (r ¼ 0.348; p < 0.05). The most common barriers to reaching clinical decisions were inadequate radiologic information (n ¼ 77), inad- equate pathologic information (n ¼ 51), and inappropriate patient referrals (n ¼ 21). CONCLUSIONS: Multidisciplinary tumor boardÀdelivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care. (J Am Coll Surg 2013;-:1e9. Ó 2013 by the American College of Surgeons) As the diagnosis and treatment of cancer gets more complex, there is a need to ensure that patients have access to the best treatment in a consistent manner. 1,2 Care for cancer patients is increasingly being delivered by multidis- ciplinary tumor boards (MTBs). 3-6 Such teams, which involve surgeons, clinical and medical oncologists, radiologists, pathologists, sometimes specialist nurses (always in the United Kingdom), and MTB coordinators, work together and meet regularly (eg, weekly) to plan investigations and treatment for patients. 2,3 There is evidence that the delivery of care by MTBs can improve diagnostic accuracy, adherence to clinical practice guide- lines, and some clinical outcomes. 7-9 However, MTBs do not always function optimally, and their clinical decision making can be variable. 10,11 This is critical, as the quality of the care that is delivered by an MTB is only as good as the quality of the clinical decision-making process that precedes it. 12 Two recent reviews of the cancer literature by our team show that the ability of an MTB to make a treatment decision on first patient presentation that is appropriate for the patient and implementable within their care increases with focus on the patient and their needs, comprehensive information Disclosure Information: Nothing to disclose. The research was funded by the UK’s National Institute for Health Research and the Whipps Cross University Hospital R&D Department. Received February 8, 2013; Revised April 4, 2013; Accepted April 8, 2013. From the Department of Surgery and Cancer, Imperial College London (Lamb, Benn, Brown, Vincent, Sevdalis) and Department of Urology, Whipps Cross University Hospital (Lamb, Green), London, UK. Correspondence address: Benjamin W Lamb, MRCS, PhD, Department of Surgery and Cancer, Imperial College London, 5 th Fl, Medical School Bldg, St Mary’s Hospital, London W2 1PG, UK. email: benjamin.lamb@ imperial.ac.uk 1 ª 2013 by the American College of Surgeons ISSN 1072-7515/13/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jamcollsurg.2013.04.035