Table 3.

Quality indicators for LC-MDTs

Quality indicator	Measure	Proposed standard	Justification
General
Availability of a LC-MDT	Does the LC-MDT exist at the site?	Yes [1]	LC-MDTs are fundamental structures for the diagnostic and therapeutic approach of patients with LC
Normalized procedures of structure, organization and functioning	Does the LC-MDT count on normalized procedures of structure, organization and functioning?	Yes [1]	LC-MDTs must be multidisciplinary and organized so that the activity is based on professional knowledge and skills and on agreed decision-making
Periodic report of the LC-MDT activity	Does the LC-MDT prepare an annual activity report?	Yes [1]	Continuous evaluation, activity monitoring and improvement are necessary
Independent evaluation of the LC-MDT activity	Is there an external audit at least every 3 years?	Yes	A positive external evaluation guarantees the quality of the LC-MDT performance
Quick access to relevant clinical information	Does the LC-MDT have a system for accessing clinical data?	Yes	LC-MDTs must have electronic access to any type of relevant information for decision-making, as well as technical support to be able to present it appropriately
Record of clinical decisions	Does the LC-MDT have a system for recording activity?	Yes	LC-MDTs must have an agenda or electronic folder where decisions are recorded, thus ensuring the traceability of clinical decisions The treatment plan must be available to all members of the LC-MDT and must be included in the electronic records
Computer management tools	Does the LC-MDT have an electronic platform for managing clinical cases?	Yes	LC-MDT functioning can be optimized through computer applications to manage information for decision-making, as well as with traceability and automatic preparation of minutes of meetings
Agenda organization	Is the participation of members on the LC-MDT included in their work agenda?	Yes	LC-MDT activity must be considered as a healthcare activity by organizations and requires exclusive dedication time
Continuous update of clinical protocols	Does the LC-MDT update annually the clinical protocols?	Yes	It is necessary to incorporate scientific findings into clinical practice
Involvement in multidisciplinary research	Is the LC-MDT involved in research projects?	Yes	Multidisciplinary research favors communication between specialties and can positively impact in the care of LC patients
Educational retrospective review sessions	Does the LC-MDT hold annual review sessions?	Yes	Retrospective review of cases has an educational aim and contributes to continuous improvement of decision-making
Participation in clinical trials	Do patients evaluated by the LC-MDT have options to participate in a clinical trial?	Yes	Clinical trials may represent an opportunity for patients with cancer. LC-MDT members must facilitat early access to them
Clinical implementation of LC-MDT decisions	N presented to the LC-MDT in which the decision agrees with the treatment administered/N presented to the LC-MDT × 100	> 90%	LC-MDT decisions are evidence-based and supported by guidelines and multidisciplinary agreed protocols. In the face of a deviation from the initial recommendation, cases must be resubmitted and changes must be justify and recorded
Efficiency of the LC-MDT	N with LC included in more than one session of the LC-MDT*/N with LC included in the LC-MDT × 100	< 5%	The repeated presentation of cases without the necessary tests for decision-making is one of the main inefficiency problems of LC-MDTs
Multidisciplinary evaluation of patients with a new diagnosis	N with a new diagnosis of LC evaluated in the LC-MDT/N with a new diagnosis of LC × 100	> 90% [48]	Decision-making must be based on the exchange of knowledge and experience among the different specialties
Multidisciplinary evaluation of patients with recurrence	N with recurrence evaluated in the LC-MDT/N with recurrence × 100	> 90% [48]	Decision-making must be based on the exchange of knowledge and experience among the different specialties
Multidisciplinary evaluation of patients after radical surgery	N after radical surgery evaluated in a tumor committee/N after radical surgery × 100	> 90% [48]	Decision-making must be based on the exchange of knowledge and experience among the different specialties
PET staging in patients subsidiary for potentially curative treatment	N presented with curative intent in the LC-MDT with PET/N presented with curative intent in the LC-MDT × 100	100% [49]	PET is crucial for the proper staging of LC

LC Lung cancer, LC-MDT Lung cancer multidisciplinary team, N Number of patients, PET Positron emission tomography

*Excluding cases revaluated after surgery or recurrences