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Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework
  1. Ashika D Maharaj1,
  2. Sue M Evans1,2,
  3. John R Zalcberg1,3,
  4. Liane J Ioannou1,
  5. Marnie Graco3,
  6. Daniel Croagh4,
  7. Charles H C Pilgrim3,
  8. Theresa Dodson4,
  9. David Goldstein5,
  10. Jennifer Philip6,7,
  11. James G Kench8,
  12. Neil D Merrett9,
  13. Rachel E Neale10,
  14. Kate White11,
  15. Peter Evans12,
  16. Trevor Leong13,
  17. Sally E Green1
  1. 1Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
  2. 2Cancer Council Victoria, Melbourne, Victoria, Australia
  3. 3Alfred Health, Melbourne, Victoria, Australia
  4. 4Monash Health, Clayton, Victoria, Australia
  5. 5UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
  6. 6St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  7. 7University of Melbourne, VCCC, Parkville, Victoria, Australia
  8. 8Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
  9. 9Western Sydney University, Penrith South, New South Wales, Australia
  10. 10QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  11. 11Sydney Nursing School, Sydney, New South Wales, Australia
  12. 12Peninsula Health, Frankston, Victoria, Australia
  13. 13Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  1. Correspondence to Professor Sally E Green, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, VIC 3004, Australia;{at}


Background Evidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.

Objectives (1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).

Methods Semistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.

Results In total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).

Conclusions The internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.

  • quality improvement
  • clinical practice guidelines
  • health services research
  • implementation science
  • patient-centred care

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  • Contributors ADM, SME, JZ, LJI and SEG designed the study. DC, CP, TD, DG, MG, JP, TL, KW and PE were part of the focus group. ADM and SEG conducted the interviews. ADM thematically coded the data once transcribed and MG independently analysed a sample set. ADM prepared the manuscript. All authors edited and reviewed the manuscript and gave approval for submission of the final manuscript.

  • Funding This study was funded by the National Health and Medical Research Council (grant number: APP1125395).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from Monash University Human Research Ethics Committee (MUHREC): project number 19446.

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

  • Data availability statement All relevant data are included in the article or uploaded as supplementary information. Data were collected using a qualitative approach from healthcare practitioners and specialists. Further data can be made available upon reasonable request to the corresponding author.

  • 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.

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