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What We Mean by ‘Multidisciplinary Team Approach’

December 14, 2014 | AONN+ Blog
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Professor of Surgery, Johns Hopkins University School of Medicine; Co-Developer, Work Stride-Managing Cancer at Work, Johns Hopkins Healthcare Solutions

For awhile now, we’ve been hearing this phrase “multidisciplinary team approach.” It is included on documents that patients receive when they come to a cancer center for care. It is commonly heard on the radio as a marketing ploy to encourage people to come to their cancer center. But what does it really mean, and are patients benefiting from it?

There are many configurations of this team: a patient seeing a surgeon and a medical oncologist, or the patient seeing a surgeon and a radiation oncologist. How about all 3 together? Or as a tandem team? Then let’s add in a radiologist, pathologist (although he or she doesn’t actually “meet” the patient), the nurse navigator, the patient navigator, the nurse practitioner (or several different ones), a plastic surgeon, a cancer rehabilitation therapist, a genetics expert, a social worker, and possibly others.

I am a strong believer in “just in time” appointments. I am not a fan of seeing a patient because the patient is “there.” So a pivotal role for a nurse navigator can be determining who among the multidisciplinary team this specific patient she is helping needs to see: when, where, and why. If a patient has early-stage cancer with a less than 10% chance of needing chemotherapy, why would we want that patient to see a medical oncologist at the time of their initial multidisciplinary consultation? Patients want to have definitive answers, now that they have been diagnosed and are living, initially, with uncertainty. Telling a patient she might or might not need chemotherapy, and launching into information about chemotherapy regimens, side effects, and schedules only increases anxiety.

It seems better to arrange appointments as needed, once new information becomes available, thus making the consultation part of a decision-making process. For example, proactively booking a patient with breast cancer to see a medical oncologist 10 days postoperatively makes sense. Full pathology will be back from the patient’s breast cancer surgery, enabling the medical oncologist to provide specific information about treatment recommendations based on pathology results and other medical and psychosocial information. Perhaps this is where the expression “Timing is everything” came from!

I do think it is important for newly diagnosed patients with cancer to be made aware that professionals from many disciplines are and will be involved in caring for them. Depending on their specific needs, it will be determined when patients will meet with that professional and what he or she will be doing for them. It is also important for patients to know about professionals working on their behalf who they likely will not form a relationship with at a personal level (like the pathologist) but who are integral to their care.

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