Quality studies of a multidisciplinary tumour conference for head and neck oncology

Abstract

Background: When investigation of patients with suspected Head&Neck tumours have been completed he/she is presented at a multidisciplinary tumour conference at Sahlgrenska University Hospital to establish a diagnosis and tumour classification and make treatment suggestions. As the travelling distances in the region can be long, it is possible to participate in the conference using video conference technology.The objective of this thesis was to analyse quality factors associated with the tumour conference. Methods: After the patients' investigation material was presented at the tumour conference, decisions were made about diagnosis, tumour classification and treatment suggestion. A new assessment was then made with the patient present in person and differences compared with previous decisions were registered. Questionnaires were used to evaluate the patients' satisfaction with the tumour conference.A record was kept of the frequency with which the tumour conference was able to establish a diagnosis and a treatment decision and the reasons for a lack of decision. Further data registered were the time between the therapy decision and the start of treatment, and the frequency of and reasons for changes to the tumour conference decisions prior to the start of treatment. Based on information from the patient questionnaires, the cost to participate in the tumour conference was calculated. The cost of using video conference equipment and of physicians from DGHs (District General Hospital) attending the tumour conference was calculated. Results: The tumour classification or treatment plan changed for nine per cent of the patients after they had been assessed following participation in person. The patients who participated in person at the tumour conference were seldom (15%) accompanied by their physician, while the patients who participated using video conference technology were always accompanied by their physician, which influenced the patients' experience of satisfaction. A quarter of the patients who had been referred to the tumour conference needed to supplement their examinations. The clinics which more frequently allowed their physicians to take part in the tumour conference required additional examinations less frequently. The waiting time for treatment at an ENT clinic and an Oncology clinic was 19 days and 38 days respectively. At the start of treatment, the classification or treatment plan was changed for 1.4% of the patients. When a patient and physician from a DGH took part in the tumour conference, the cost was SEK 5,366, while the cost of participating using video conference technology was SEK 2,036.Conclusions: If the patient attends the tumour conference, a greater precision in the diagnosis is achieved. In addition, patients feel that it is valuable for them to take part in the tumour conference and they also feel that they are supported if their physician from the DGH accompanies them. A large percentage of the patients who are presented at the tumour conference require additional examinations. The decisions made at the tumour conference are still valid at the start of treatment. In socio-economic terms, it is more effective to allow a patient from a DGH to take part in the tumour conference using video conference technology.