Patients' Non Medical Characteristics Contribute to Collective Medical Decision Making at Multidisciplinary Oncological Team Meetings
Background The contribution of patients' non medical characteristics to individual physicians' decision making has attracted considerable attention, but little information is available on this topic in the context of collective decision making. Medical decision making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Design Observations were conducted at a French Cancer Centre during MDT meetings at which non standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. Results In the final sample of patients' records included and discussed (N 290) non medical characteristics were mentioned in 32.8% (n 95) of the cases. These characteristics corresponded to demographics in 22.8% (n 66) of the cases, psychological data in 11.7% (n 34) and relational data in 6.2% (n 18) The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non medical characteristics and with uncertainty about the outcome of the therapeutic options available. Limitations The design of the study made it difficult to draw definite cause and effect conclusions. Conclusion The Social Representations approach suggests that patients' non medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients' attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.
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