COVID-19 and the multidisciplinary team meeting: ‘Should old acquaintance be forgot?’

In healthcare, a multidisciplinary team (MDT) constitutes a group of individuals working collaboratively from different disciplines who discuss and decide the most appropriate investigations and optimal management of patients.1 MDT meetings help synthesise the collective knowledge, experiences and opinions from a range of specialists with the ultimate aim of streamlining the management of both acute and chronic medical conditions and disease processes. Its ultimate aim is to improve outcomes in a holistic bespoke manner. In recent times, there has been an explosion in all areas of healthcare where the MDT has a prominent and pivotal role to play, with such a process often being recommended by national guidelines and considered to represent a ‘gold standard’ prerequisite.1,2 A slowly increasing rich breadth of data demonstrate that MDTs can improve patient-centred outcomes,3–4 while ‘softer’ benefits such as education and training opportunities, fostering of relationships and enhanced interprofessional communication, a sense of ‘being included’, and team working are likely to occur.

The COVID-19 pandemic has necessitated a major change in the MDT landscape. Historically, most MDT meetings were likely to have involved the majority of participants congregating in the same room allowing ease of contribution and participation. However, the need to socially distance and national governing bodies advocating working at home wherever possible, have meant that virtual MDTs have now become commonplace, verging on the norm in many circumstances. Given such a major change in the working patterns of MDTs and its participants has evolved through necessity in a short period of time, it has become gradually apparent that both benefits and drawbacks occur (Table 1). Moreover, uncertainty exists as to whether the remotely operating MDT should remain, and, if so, what factors need to be put in place in order to optimise the smooth running of the process and ensure outcomes are similar to the pre-COVID-19 era. Different software platforms also exist that all have differing advantages and disadvantages.5 For example, Microsoft Teams has gained widespread popularity by the UK National Health Service (NHS) and is generally accepted to be secure and reliable. It also boasts other benefits, all of which are designed to aid communication and networking. Commercial platforms such as Skype and Zoom tend to be less secure and currently not advocated for use in the NHS.

Table 1 Advantages and disadvantages of virtual multidisciplinary team meetings

Unfortunately, few data exist that support the notion that virtual MDT working should either remain or gradually metamorphose back into the traditional model. However, one small questionnaire study explored opinions after eight virtual MDTs. Of respondents (n = 36), 73% and 83% considered that the depth of discussion and decision-making processes had not changed versus the traditional MDT.6 In a further study,7 a questionnaire was distributed to all head and neck MDTs in the UK, of which there were 97 responses. Most respondents (70%) considered that decision-making was unchanged, while 85% felt that technology was satisfactory, and approximately three quarters felt that some aspects of communication (for example viewing of images and slides) were ‘as good’ or ‘better’. However, it was felt that engagement, team working and training were poorer versus traditional working.

If virtual MDTs are here to stay for the short to medium term, drawing up and widespread adherence to a list of ‘rules of engagement’ need to be considered. Any such guidance is likely to be dynamic, and vary between institutions and subject nature of the MDT. However, it seems reasonable to consider that such ‘rules’ can be categorised as healthcare institution, local organisational and participant specific (Table 2). It does need to be borne in mind that while virtual attendance is comparatively easy and can occur within the confines and comfort of an individual’s own home, ability to pay attention and avoid distractions are far more challenging to practice and sustain.

Table 2 Suggested prerequisites of an ideal multidisciplinary team (MDT) meeting

In summary, it is likely that remote working MDTs are here to stay in some form or another. In some institutions, as restrictions continue to ease, increasing numbers of MDT participants may decide to collectively congregate once again. Further larger studies are required into the acceptability and effectiveness of virtual MDTs to all participants, and whether or not the virtual platform has any bearing on meeting duration; perhaps one further unexplored facet is what the extent of different team members verbal contribution is altered by the virtual versus the traditional model. As the use of virtual platforms continues to increase exponentially in healthcare systems, not only for MDTs, but meetings and communication in general, let us all continue to reflect and ask ourselves: Am I essential to this meeting? Am I paying attention? Am I contributing? Am I adhering to appropriate etiquette? Would the MDT experience be better (and feasible) in a non-virtual room? And, finally, as the new light of 2022 beckons, let us all keep in mind the rhetorical question – which can equally be applied to the pre-COVID-19 MDT – posed by Robert Burns in Auld Lang Syne. In his world famous song he laments ‘Should old acquaintance be forgot, and never thought upon?’ which, according to Wikipedia translates roughly as ‘is it correct that old times are forgotten?’.

References

1 NICE Guideline 94 March 2018. https://www.nice.org.uk/guidance/ng94/evidence/29.multidisciplinary-team... (accessed 01/11/21).

2 MDT development - working toward an effective multidisciplinary/multiagency team. https://www.england.nhs.uk/wp-content/uploads/2015/01mdt-dev-guid-flat-f... (accessed 01/11/21).

3 Taylor C, Shewbridge A, Harris J et al. Benefits of multidisciplinary teamwork in the management of breast cancer. Breast Cancer 2013; 5: 79–85.

4 Prades J, Remue E, Hoof E et al. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2015; 119: 464–74.

5 Khincha PP, Chauhan V, Ekwobi CC. COVID-19: the impetus for change-sustaining healthcare team communication in times of social distancing. Eur J Plast Surg 2020; 1–4.

6 Rajasekaran RB, Whitwell D, Cosker TDA et al. Will virtual multidisciplinary team meetings become the norm for musculoskeletal oncology care following the COVID-19 pandemic? - Experience from a tertiary sarcoma centre. BMC Musculoskelet Disord 2021; 22: 18.

7 Mohamedbhai H, Fernando S, Ubhi H et al. Advent of the virtual multidisciplinary team meeting: do remote meetings work? Br J Oral Maxillofac Surg 2021; 27: S0266-4356(21)00206-0.