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Raine R, Wallace I, Nic a’ Bháird C, et al. Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.37.)
Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study.
Show detailsMDT STUDY: Patient interview TOPIC GUIDE
VERSION 1, 28.3.12
INTRODUCTION FOR PATIENTS
This research aims to understand clinical decision-making processes through the eyes of the patient. There will be three sections to the interview. First, we’d like to hear about your experience of your care so far. Then we’ll move on to how you and your healthcare team make decisions about your care. Finally, we’ll discuss more generally how you feel patients should be involved in these kinds of decisions.
We would like to emphasise that the study is being conducted by UCL and we are not employed by your Trust or the NHS.
We wish to reassure you that you do not have to answer any question you feel uncomfortable with and you can stop the interview at any time. This will in no way affect your care.
This is about getting your views across. Your responses will be confidential: they will not be shared with your healthcare team. Quotes from the interviews may be used in our findings, but it will not be possible to identify you or your healthcare team from these.
Interviewer will then talk through patient information sheet if patient/carer wishes
Warm up - I’d like to start by asking you about your condition and your care
- Could you briefly tell me about your [condition] and the most important ways that it affects you?
- Encourage focus on main condition (focus of MDM) & impact on quality of life
- What types of care do you currently have for your [condition]?
- Encourage brevity & focus on major health (+/– social care) interventions
- Can you describe how decisions were/are made about your care?
- Who are the main people involved in making decisions about your care? i.e. are respondents aware of multidisciplinary team (MDM) vs. individual consultant making decision?
- What involvement did you have in making decisions/planning care?
- What were your preferences/wishes regarding your care?
- Can you describe any times when you were invited to discuss or choose any aspects of your care?
- Did you want to make choices? Does it depend on the type of decision?
- Please can we talk in more detail about a particularly important decision that was made about your care? This may include a treatment, diagnostic procedure, something about the timing, setting (inpatient/outpatient) or anything else such as a second opinion.
- Can you describe how you made your decision to/not to receive this care? Can you tell us the factors that influenced the decision?
- Any perceived concerns/benefits e.g. side effects; time in hospital; convalescence time; enormity of procedure; quality of life etc.
- Where they received information from (e.g. family, friends, reading, clinical staff)
- Which of these factors made a difference to the decision made? Why?
- Extent to which their choice/decision was influenced by personal characteristics e.g. belief systems (fatalism, faith, ‘willing to try anything’, autonomy [want to retain personal control], delegation [want their Dr to make important decisions] etc.)
- Extent to which personal characteristics interacted/were mediated by context e.g. their relationship with key health professionals / the importance of the decision/uncertainty surrounding management options etc.
- Is there anything about your care that you know now, that you would like to have known before?
- Side effects, time in hospital, recuperation issues, specified risks etc.
- How might this information have changed your care preferences/decision?
MDT meetings - increasingly in the NHS, patient care is managed by a team of professionals with different skills, rather than one person. For example, [insert relevant mix of professionals] may meet together once a week to discuss different cases. Patient care decisions are often made in these in ‘multidisciplinary team meetings’, by the whole (multidisciplinary) team.
- What do you know about these meetings?
- Do you know that your care is discussed?
- Were decisions fed back to you?
- What do you think about this way of working?
- How do you feel about your care being discussed in these meetings?
- What were/are the important things about you that you would want the multidisciplinary team to consider when they meet to discuss your care/management?
- What were/are the important things about your care that you would want the multidisciplinary team to consider when they meet to discuss your care/management?
- Defined benefits and concerns e.g. side effects; time in hospital; convalescence time; enormity of procedure; quality of life etc.; importance of short versus long term effects
- Timing; setting etc.
- When is the most appropriate time to discuss this information with you?
- How should it be done & how often? e.g. before or after the MDT
- Who would you want to represent your views at a multidisciplinary meeting (key health professional; patient advocate; patient/carer)?
- Are there issues that you would wish to remain confidential (not to be shared) when the team is discussing management options for you?
- As appropriate, probe, with sensitivity:
- Comorbidities; risky behaviours; personal circumstances (do NOT press to define these if the patient does not volunteer the information).
In this final section, I’d like to talk more generally about how you think multidisciplinary teams should work
- Do you think it is important for multidisciplinary teams to always consider patients’ views when making a decision about care?
- As appropriate, probe the influence of:
- Context e.g. major decisions (to have a major intervention or not etc.) versus decisions about process (scheduling, setting etc.);
- Intervention specific issues e.g. where there is clinical uncertainty about options; quality of life (pain, impact on mobility/independence etc.)
- What information should be fed back to patients about the multidisciplinary team meeting decision-making process about their care?
- As appropriate, probe:
- How the MDT decided what to recommend e.g. whether it was protocol/evidence based; the specialties involved in making the decision; options discussed; factors which influenced the decision etc.
- Do you have any suggestions for ways for patients’ views to be represented at the multidisciplinary team meeting?
- As appropriate, probe:
- Some suggestions include: staff known to patient attend; patient advocate attends; preparatory meeting with patient; patient preferences written down in advance; patient submits a written statement; patient/carer attends meeting; formalised feedback after the meeting; decision options discussed with patient after meeting etc.
- How would this work in practice? e.g. would they find it upsetting, would they understand the discussion, would it be intimidating; is it feasible (work & family commitments)?
- What about for patients who feel unable to express their view/ask questions?
Finally, is there anything else about how patients are involved in decisions about their healthcare that you would like to add?
- Patient interview topic guide - Improving the effectiveness of multidisciplinary...Patient interview topic guide - Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study
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