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      Onkologische Pflege im Tumorboard : Rolle der Pflege in der multidisziplinären onkologischen Versorgung Translated title: Cancer nursing on tumor boards : Role of nursing in multidisciplinary oncological care

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          Abstract

          Hintergrund

          Die immer komplexer werdenden Therapiemöglichkeiten onkologischer Erkrankungen mit multimodalen Behandlungsstrategien überschreiten die Grenzen einer einzelnen Fachdisziplin und erfordern eine multidisziplinäre Zusammenarbeit, um eine leitliniengerechte und patientenorientierte Versorgung zu gewährleisten.

          Material und Methoden

          Die Durchführung eines effektives Tumorboards wird in den Zielen des Nationalen Krebsplans des Bundesministeriums für Gesundheit und in den Zertifizierungsvorgaben der Deutschen Krebsgesellschaft vorausgesetzt.

          Ergebnisse

          In Deutschland wird bisher die Fachkompetenz aus dem Bereich der onkologischen Pflege eher selten eingebunden.

          Schlussfolgerung

          Die Konferenz Onkologischer Kranken- und Kinderkrankenpflege (KOK), eine Arbeitsgemeinschaft der Sektion B in der Deutschen Krebsgesellschaft e. V., arbeitet intensiv an der Stärkung der Rolle onkologischer Pflege, damit onkologische Fachpflegekräfte und onkologisch spezialisierte Advanced Practice Nurses, als integraler Bestandteil des multidisziplinären Teams, wertvolle pflegefachliche Aspekte unter Einbezug der individuellen Patientenperspektive einbringen und so die Qualität der onkologischen Versorgung verbessern können.

          Translated abstract

          Background

          The increasingly complex treatment options for oncological diseases with multimodal treatment strategies transcend the boundaries of a single discipline and require multidisciplinary cooperation in order to ensure guideline-based and patient-oriented care.

          Material and methods

          The implementation of an effective tumour board is required in the goals of the National Cancer Plan of the Federal Ministry of Health and the certification guidelines of the German Cancer Society.

          Results

          In Germany, specialist competence in the field of oncological nursing has so far rarely been integrated.

          Conclusion

          The Konferenz Onkologischer Kranken- und Kinderkrankenpflege (KOK), a working group of Section B in the German Cancer Society, is working intensively on strengthening the role of oncological nursing so that oncological nurses and advanced practice nurses specialising in oncology, as an integral part of the multidisciplinary team, can contribute valuable nursing aspects, taking into account the individual patient perspective, and thus improve the quality of oncological care.

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          Most cited references6

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          Multidisciplinary teams in cancer care: are they effective in the UK?

          Cancer care can be complex, and given the wide range and numbers of health-care professionals involved, an enormous potential for poor coordination and miscommunication exists. Multidisciplinary teams (MDTs) should improve coordination, communication, and decision making between health-care team members and patients, and hopefully produce more positive outcomes. This review describes the many practical barriers to the successful implementation of MDT working, and shows that despite an increase in the delivery of cancer services via this method, research showing the effectiveness of MDT working is scarce.
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            Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: an interview study of the provider perspective.

            It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. Semi-structured interviews were carried out with expert MDT members of Urological and Gastro-Intestinal tumours of 3 London (UK) hospitals. The standardised interview protocol assessed MDT experts' views on decision-making, barriers to reaching a decision and implementing it into care, and interventions to improve this process. All interviews were audio-taped, transcribed verbatim and analysed using a standardised approach. Emergent themes were identified by 2 clinical coders and tabulated. Twenty-two participants participated in the study and data collection achieved 'saturation' (i.e., similar themes raised by different participants). Barriers to clinical decision-making included: inadequate clinical information; lack of investigation results; non-attendance of key members; teleconferencing failures. Barriers to implementation of MDT recommendations included: non-consideration of patients' choices or co-morbidities; disease progression at the time of implementation. Proposed interventions included improving the information available for the discussion through a standardised proforma; improving video-conferencing; reducing the MDT caseload (e.g., via selective MDT review of certain patients); and including patients more in the decision process. There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.
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              Development and testing of the cancer multidisciplinary team meeting observational tool (MDT-MOT)

              Objective To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. Design Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. Setting Study 2 included 10 cancer MDMs in England. Participants Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. Intervention None. Main Outcome Measures Tool development, validity, reliability/agreement and variability in MDT performance. Results Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance ( P ≤ 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (≥80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6–7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs ( P ≤ 0.01). Conclusions MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance.
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                Author and article information

                Contributors
                knoetgen@kok-krebsgesellschaft.de
                Journal
                Onkologe (Berl)
                Onkologe (Berl)
                Der Onkologe
                Springer Medizin (Heidelberg )
                0947-8965
                1433-0415
                25 September 2020
                : 1-5
                Affiliations
                GRID grid.459687.1, ISNI 0000 0004 0493 3975, Frauenklinik, , Ubbo-Emmius-Klinik Aurich, ; Aurich, Deutschland
                Article
                836
                10.1007/s00761-020-00836-0
                7517068
                b13a8954-5c28-4b15-be67-8dad0cf59940
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Categories
                Leitthema

                arzt-pflegekraft-beziehung,interprofessionelle beziehungen,onkologische versorgung, krankenhaus,patientenversorgungsteam,multidisziplinäre kommunikation,physician-nurse relations,interprofessional relations,oncology service, hospital,patient care team,multidisciplinary communication

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