Table 3.

Quotations About the Theme: Consensus and Accountability on Consistent Care

Participant Number	Indicative Quotation
16	“Often it will involve chatting to three or four different people who you cannot get in the one place, and it’s really difficult to get some kind of consensus, whereas for the complex cases, it’s a really valuable venue for I guess discussing the controversies and coming to some kind of consensus position.”
13	“I think that for complex patients, it’s important that every clinician looking after that patient sings from the same song sheet, that there’s no confusion.”
5	“I think the [tumour type] MDT is crucial in determining a comprehensive treatment plan for [tumour type] cancer patients because … many people are treated with multiple modalities of treatment … our patients often have significant comorbidities which need to be accounted for in determining that management plan.”
2	“I think it’s also good to ensure that you do not just have one person doing their own thing unchecked. It’s good that as a group we can make sure that the management is appropriate. … When we review it at the meeting, we realise actually there’s a small area where the margin’s involved. And as a forum we are not happy to let this patient go without having more surgery.”
6	“I think MDMs have restricted the diversity of treatment protocols that are used … I think people come with preconceived notions, and sometimes their ideas are changed when they come to that meeting. And that’s why we are there. So, we learn from each other. We change sometimes our fixed opinions.”
1	“The important ingredient is collegiality, really, and developing a team that is prepared to advise by evidence-based medicine, where the evidence exist. If you get people who are wanting to push their own barrows, for example, radiation or chemotherapy or surgery, and it’s not based on evidence, well, then, of course, it will not work well.”
13	“if you go against what the MDT have recommended, you’re seen as an outlier.”
6	“I attend for various reasons. One, is the patient care, so gaining consensus around treatment of patients with various conditions.”
7	“It will simply get documented in the MDT letter and in the MDT notes that consensus was unable to be reached. And that these are the options that were discussed and that will obviously get sent out to the GP and the referring doctor. The clinicians themselves, it’s up to them whether they want to document that in the patient’s electronic file.”
16	“I do not have any hard and fast rules, but I think if the discussion is not progressing after three or four minutes, then I think that’s the point where I would suggest, well, is there a consensus? No, there’s not, so we are going to document it as such.
10	“I make a huge effort to get consensus around our recommendations in our meeting. So, I actually … We have our database on screen and I actually make a point of saying these will be the recorded recommendations.”
15	“It’s followed virtually 100% locally, but some patients, I’m talking maybe 5% end up at other treatment centres, tertiary centres, and they will do something different to what we’ve recommended, yes.”
2	“The majority do so we’d probably be looking at probably maybe 80% I would say you do end up following what was discussed. But then there’d be the other 20% where the patient may not agree with what the plan was or may not be fit enough for that plan.”