Table 3. Limitations for VMDTMs reported across included studies.
| Limitations | Comment |
|---|---|
| Organization | |
| Lack of reimbursement | For attending physicians, the lack of reimbursement for presenting cases in VMDTMs was a barrier to attendance, as described in two studies fourteen years apart [30, 46]. In the study by Shea et al., this was an important barrier for community-based physicians [46]. |
| Scheduling | Clash with other commitments was reported as a scheduling issue in two studies [28, 38]. Like other meetings, it is necessary to consider VMDTMs consistently like any other meeting in order to not let the virtual ease of attending the format create scheduling problems. |
| Preparing cases is time-consuming | Although participants in two studies reported that preparing cases was time-consuming [46, 49], participants in other studies reported that they had adequate time [19, 28]. Furthermore, VMDTMs were deemed time-efficient in other studies [17, 23, 43]. |
| Case Discussion and Decision-Making | |
| Varying level of preparedness of participants | Rosell et al. reported that discussion quality is limited if participants are unprepared for the meeting [49]. This necessitates that attending participants should prepare for the cases well before the meeting. |
| Lower commitment for referred cases | Rosell et al. reported that participants in meetings showed lower dedication towards referred cases [49]. |
| Resolution within one specialty | Delaney et al. reported the decision-making was majorly reserved within one specialty [50]. This is in comparison to multiple other studies that reported adequately shared decision-making [7, 17, 22, 23, 35, 47, 48]. |
| Teamwork and Communication | |
| Loss of non-verbal cues cause misunderstandings | Misunderstandings due to unacknowledged uncertainties was reported by multiple studies [19, 49, 50]. A solution for this drawback was reported by Ali et al. who recommended making use of hands-up alerts present within the software [17]. |
| Impersonal nature affects meetings | According to Delaney et al. the impersonal nature of the virtual format, inevitably eliminated a considerable amount of social aspects such as the ability to joke with colleagues, open conversation, and the equality between participating centers [50]. |
| Education/Training | |
| Training | Only participants in the study by Mohamedbhai et al. believed that training was poor in VMDTMs compared to the in-person format [23]. In stark contrast, all the other studies noted that VMDTMs are beneficial and good at offering clinical education and training [17, 18, 20, 27–30, 33–35, 39, 41, 42, 46, 49]. |
| Technology | |
| Connectivity | Internet connectivity and limited bandwidth was the most commonly described technical limitation [17, 19, 21, 30, 43, 46, 49]. It was deemed an important barrier to VMDTMs. The implications of poor connectivity were described as: the inability to see other participants [49], misunderstandings between participants [49], compromised case-discussion [43, 46], and meeting delays [44]. |
| Audio/video quality | Audio/video quality was satisfactory across all studies that evaluated these aspects of VMDTMs [5, 22, 29, 34, 35, 50]. The reported consistency of adequate audio/video quality was reported as far back as 1999 in the study by Hunter et al. [5]. |
| Image quality | In 2000, Olver et al., reported concerning image quality [30]. However, subsequent studies in recent years have reported adequate or an even better image quality compared to IMDTMs [17, 19, 21, 23, 27]. |
| Logistics of handling patient data | Olver et al. reported, in the year 2000, that displaying radiology and pathology information was difficult [30]. In the year 2020, Rosell et al. considered the process of transferring radiology slides time-consuming but did not comment on the level of difficulty [49]. In a 2013 study by Abu Arja et al., pathology slides were easy to transfer, but no comment was made on whether the process was time-consuming or not [28]. |
| Lack of technical support | The lack of technical support was a barrier to attendance in the study by Bonanno et al. [19]. Similarly, the study by Ali et al. cited that the availability of technical support would be an important improvement for VMDTMs [17]. In the study by Chekerov et al., technical support was deemed adequate [39]. |
| Patient-related aspect | |
| Clinical trial recruitment | A majority of VMDTM participants agreed that VMDTMs are valuable in identifying patients for clinical trials. However, a considerable portion of respondents, in the same studies, were unsure or disagreed, which put this aspect of VMDTMs into doubt [18, 41] |
| Concerning patient confidentiality | Olver et al. reported concerns with patient confidentiality in the year 2000 [30]. However, confidentiality over the years has improved and is comparable to IMDTMs [17, 23, 27], in recent years. |
| Limited consideration of patient comorbidity and perspectives | Only the studies by Rosell et al. evaluated consideration of patient perspectives or comorbidity in VMDTMs [42, 49]. Thematic analysis of semi-structured interviews reported a limited consideration in comparison to 71–79% of participants agreeing that patient views are taken into account during VMDTMs [42, 49]. |
Abbreviations: IMDTM, in-person multidisciplinary team meeting; VMDTM, virtual multidisciplinary team meeting.
Note: This table lists down all limitations of VMDTMs as they were identified amongst the included studies. The table offers an explanation, solution, or a general comment on each limitation which is supported by data from existing literature.