Table 4.
Overview of Strategies to Improve Patient-Centeredness
| Category | Subcategory | Strategy | Corresponding Need |
|---|---|---|---|
| Organization | People management | Involve staff with an attention to patient-centered information (nurse, psychologist, social worker, geriatrician, general practitioner, clinician familiar with patient). Delegate goal clarification to general practitioner.a Attendance of clinician who is familiar with the patient. |
Patient-centered information. Knowing goals and preferences. Individualized information. |
| Information management | Show picture of patient on screen.a Enable teleconferencing for eg general practitioner, physician from referring hospital.a |
Patient-centered information. Individualized information. |
|
| Meeting management | Organize more or longer MDT meetings to relieve time pressure.a Guarantee adequate MDT preparation time for physician in charge of patient. Introduce structured patient presentation. Guarantee access to patient information timely before MDT meeting, also with referrals. Oblige completing patient file before MDT meeting. Chair is responsible for patient-centeredness. Co-chair with secretary role. Chair works following strict principles. |
- | |
| Education | Train MDT on Shared Decision-Making (SDM).a Train chair for patient-centeredness.a Exchange best practices between MDTs. Teach patient-centeredness to interns/residents. Teach chairing task to interns/residents. |
- | |
| Decision-making | MDT process | Select patients for detailed discussion or short discussion. Discuss alternative treatments with pros and cons.a Case close off with recommendation, arguments/rationale, and level of agreement.a Do not aim for consensus in complex cases, but eg, provide a list with options.a Postpone decision to next meeting in referral patients instead of giving a conditional advice. |
Patient-centeredness during MDT decision-making process. |
| Patient process | Elicit patient values, preferences, and goals with tools.a Make asking values, preferences, and goals a routine. Use decision aid.a Support of GP to clarify values.a Invite the patient to MDT meeting,a or have two consecutive meetings with and without patient. |
Patient-centeredness in consultation with the patient. Patient-centered information. Knowing goals and preferences. Individualized information. To discuss information with the patient. |
|
| Patient advocacy | Assign a patient advocate (nurse, GP, physician in charge).a Define the role of the patient advocate, eg to present the patient, to clarify the values, to ask patient-centered information, to advocate the patient’s opinion. |
Patient-centered information. Knowing goals and preferences. |
|
| Communication | Information to MDT | Presence of professional with info, eg, nurse, assistant, general practitioner, physician in charge, geriatrician. Standardize collection of patient-centered information or individualized medical information by: - Questionnaire, tool, or list.a - Text block in MDT forms. - Work-up-day to gather all information in one day Determine a standard presentation format including the mentioning of patient-centered information. All involved specialties prepare relevant cases. |
Patient-centered information. Knowing goals and preferences. Individualized information. |
| Information following MDT | Standardize the written report, including options, pros and cons, arguments, or uncertainties.a Chair supervises thorough reporting. Designate a co-chair for thorough reporting. Clinic appointment with most relevant specialties following MDT meeting (“carrousel meeting”). Physician in charge discusses MDT report with patient, eg, options, pros and cons, uncertainty. Disclose MDT written report to the patient. |
More information following MDT meeting. To discuss information with the patient. |
Note: aitems (partially) derived from the list of strategies.
Abbreviations: MDT, multidisciplinary cancer team. GP, general practitioner.