Background Multidisciplinary team meetings (MDTMs) are considered a cornerstone of oncology care, yet questions remain about their efficiency and patient-centeredness. While tools exist to guide and structure MDTMs, their integration into hospital settings is often inconsistent. Methods This feasibility study examined the use of two validated tools—the MDT-QuIC checklist and the MDT-MeDiC complexity tool—across ten Multidisciplinary Oncological Consultations (MOCs) in five Belgian hospitals. Baseline assessments were conducted using the validated MDT-MODe observational instrument. Implementation feasibility was evaluated through repeated observations at the MOCs and interviews with MOC chairs. Results Baseline data showed limited discussion of psychosocial information and patient preferences, and minimal nurse contribution. The MDT-QuIC was generally accepted as helpful for structure and role clarity, though not consistently applied due to time pressures. The MDT-MeDiC tool was considered too resource-intensive for routine use. Implementation success varied by existing structure, leadership style, and administrative support. Conclusion Structured tools can improve the organization of MOCs, but feasibility is dependent on local context. Broader uptake across health systems requires attention to team composition, preparatory workflows, and integration into supportive policy and digital frameworks. Policy summary Embedding structured MDTM tools into oncology policy, through digital integration, case complexity triaging, and incentives for psychosocial and nursing input enables efficient use of expert time while safeguarding patient-centredness.

PurposeNurses are capable of acting as advocates for patients since they hold valuable knowledge on patient preferences and their psychosocial needs. Yet, in practice they tend to contribute little to multidisciplinary team meetings (MDTMs). This study analyses the factors that influence whether or not nurses will speak up and increase patient-centred decision-making in MDTMs.Design/methodology/approachA multiple case study with cross-case comparison of twelve tumour groups across two Belgian hospitals was conducted. Data collection involved fifty structured non-participant observations and 41 semi-structured interviews with participants from the twelve tumour groups.Originality/valueThis study yields factors that increase the opportunities for nurses to speak up in MDTMs to enhance patient-centred decision-making. The findings help in the design of future interventions concerning multidisciplinary teamwork, that address nurses' contributions to augment patient-centred care.

Introduction: A timely integrated diagnostic and care trajectory for children with a developmental disability may prevent severe problems in later life. In Flanders, Belgium, different types of governmental regulated and subsidised settings offer diagnostic evaluations, as (part of) their mission. However, they operate in a non-coordinated way inducing severe accessibility problems for the public. This article studies the factors impacting on interorganisational collaboration and proposes an interorganisational conceptual model improving accessibility. Methods: Focus groups were performed per type of organisation. Qualitative data were categorised thematically in an iterative process of data- and researcher triangulation. A member check validation was organised. Results: Fifty-nine individuals participated in 6 focus groups. Structural and agency-related barriers for interorganisational collaboration were identified at micro, meso and macro level. Participants provided suggestions for better interorganisational collaboration. Discussion: To improve accessibility adapted to patients’ needs, a patient-centred, integrated and interorganisational network model grounded in a stepped care logic is proposed to adapt the current organisation-centred model. Conclusion: A timely, integrated, diagnostic and care trajectory for children with a developmental disability preventing severe problems in later life requires an integration of services during the overall care trajectory of children by means of interorganisational collaboration.

Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field. Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized. Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory. Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.

An unusual cause of acute desaturation A 61-year-old man presented with symptoms of rapidly increasing dyspnea, chest pain and significant hypoxemia for which the initial investigations revealed no clear explanation. There was a remarkable improvement of the saturation in supine position. A contrast transesophageal echocardiography established the presence of a patent foramen ovale (PFO), which was successfully closed via a percutaneous transcatheter. Platypnoea-orthodeoxia syndrome (POS) is a rare entity characterized by the presence of arterial hypoxemia in upright position with resolution of the hypoxemia in supine position. It is most frequently caused by a PFO. A PFO is, however, merely an essential precondition and the development of POS nearly always requires the presence of other (functional) factors.

Background: Frailty in non-transplant eligible (NTE) newly diagnosed multiple myeloma (NDMM) patients is associated with toxicity which can negatively affect physical functioning and quality of life (QoL). Older patients may prefer QoL and physical independence over length of life, highlighting the importance of taking health-related (HR) QoL assessment into account for treatment guidance. Methods: The HOVON123 study (NTR4244) was a phase II trial in which 238 NTE-NDMM patients ≥75 years were treated with 9 dose-adjusted cycles MPV. Nine (3 functional; 6 symptom) subscales of two HRQoL instruments (EORTC QLQ-C30 and MY20) were obtained at baseline (T0), after 3 (T1) and 9 (T2) cycles of therapy, and 6 (T3) and 12 (T4) months after discontinuation of therapy in patients without progression. The presence of “tingling hands/feet” was used as a proxy for neuropathy. Differences in baseline HRQoL were analysed with independent t-tests and changes over time with linear mixed models. HRQoL changes and/or differences were reported only when both statistically significant (p<0.005, adjusted for multiple testing) and clinically relevant (>MID). Results: A total of 137 frail and 71 intermediate-fit patients were included in the HRQoL analysis, after exclusion of fit patients and patients whose frailty status or baseline HRQoL questionnaire was missing. Compliance was not materially different in both groups. Frail patients had an inferior HRQoL at baseline in the subscales global health status, physical functioning, fatigue and pain, compared with intermediate-fit patients. Both groups reported improvements in global health status and future perspective. In contrast to intermediate fit patients, frail patients improved in physical functioning, fatigue and pain over time. The improvements in global health status were reached earlier in frail patients (T1) compared with intermediate fit patients (T2), Figure 1. In both intermediate fit and frail patients there was an increase in neuropathy. All other subscales remained within MID ranges and/or were not statistically significant different from baseline. The improvement in global health status sustained after treatment completion (T3-T4) both for frail and intermediate fit patients. This also accounted for future perspective at T3, however, at T4 for intermediate fit patients only. In contrast, the improvement in all other HRQoL domains during treatment, lost clinical relevance and/or statistical significant difference during the TFI. The deterioration in neuropathy remained until T4 in frail patients, but not for intermediate fit patients, reversing at T4, Figure 1. Conclusion: HRQoL in frail patients is inferior as compared to intermediate fit patients at diagnosis. Importantly, treatment improved HRQoL, irrespective of frailty level, being more pronounced and occurring even faster in frail patients. Therefore, physicians should not withhold therapy in these patients because of their frailty status only.

The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.

Abstract Background Children with a suspected developmental disability need early diagnostic evaluations and support, to maximize developmental opportunities. Accessibility to diagnostic settings in Flanders, Belgium, is poor, with waiting periods up to two years. Interorganisational coordination of activities using a public health and needs of the population perspective is needed to strengthen the system. This study aims to evaluate current practices and opportunities for interorganisational collaboration of organisations active in the field of diagnostics. Methods It concerns a qualitative, policy-support research project. 6 homogeneous focus groups were organised for the 6 types of organisations subsidized by the government to perform diagnostic evaluations of children with a (suspected) developmental disorders. Data were thematically analysed and categorized in a process of researcher and data-triangulation. A member check validation was done. Results 59 persons participated. We classified the hampering and facilitating factors for collaboration Current interorganisational collaboration is mostly limited to referral. Organisational differences in vision and goals, working processes and quality requirements, regulations and financial support criteria, a problem of accessibility and communication problems are hampering factors. Knowledge of mutual expertise and working processes, personal contacts and open communication are facilitating factors. Conclusions A population public health based organisation of the field of multidisciplinary diagnostic evaluations for children with a developmental disorder, with interorganisational collaboration and coordination of activities in mandated networks, sharing experience and knowledge, would increase the accessibility for all children and strenghten the health system. The implementation of interorganisational networks would benefit from a functional and institutional analysis of organisations. Key messages • Coordination of activities and interorganisational collaboration in mandated networks, could potentially improve the accessibility of diagnostic evaluations for children with a developmental disorder. • Implementation of interorganisational networks would benefit from a functional and institutional analysis of organisations.

Background Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making. Objective This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results. Methods For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design. Results The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022. Conclusions The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups. International Registered Report Identifier (IRRID) PRR1-10.2196/29004

Although multidisciplinary team meetings (MDTMs) play a large role in cancer care and are designed to facilitate multidisciplinary collaboration, nurses are often not actively involved in the discussions. With this paper we aim to to define the determinants that can increase the role of nurses in patient-centred decision-making in MDTMs. A qualitative multiple case study design with cross case comparison was used. Data collection involved 50 structured non-participant observations, 41 semi-structured interviews with participants of 12 different tumour groups and document analysis of policy documents, hospital protocols and information brochures. Three different groups of determinants are distinguished: determinants of current nurse involvement, future nurse involvement and input of psychosocial information in the MDTMs. This study concludes that here is a need for increased involvement of nurses, especially in complex cases.

BACKGROUND:Multidisciplinary teamwork has become the standard in care for oncological patients and their treatment trajectory when comprehensive, holistic, and high-quality cancer care is needed. Working together from a variety of perspectives is difficult to achieve and has well-known pitfalls, such as miscommunication and poor coordination.OBJECTIVE:To describe and synthesize the factors influencing and the processes underlying optimal multidisciplinary teamwork.METHODS:An integrative review was conducted, guided by the framework of Whittemore and Knafl. The systematic search for literature published since 2010 in 3 databases (PubMed, Web of Science, and Scopus) yielded 49 articles.RESULTS:Eighty-eight percent of the included studies focus on multidisciplinary team meetings, rather than on the wider notion of multidisciplinary teamwork. We identified influencing factors on the basis of structural features of the team, hospital, and health system, as well as process features of multidisciplinary teamwork in multidisciplinary team meetings.CONCLUSION:To improve multidisciplinary teamwork, the focus needs to be on the process of collaboration throughout the cancer care trajectory of the patient. A more integrated, interdisciplinary approach should be aimed for to recognize the role and contribution of all disciplines involved.IMPLICATIONS:A cultural change is needed toward interdisciplinary practice in hospitals to reach partnership between all involved professionals as part of a participatory, collaborative, and coordinated approach.

Introduction Since the end of 2019, measures have been taken to control the spread of COVID-19. The effects of the pandemic-related precautionary measures on children with developmental disorders require specific attention as these children have greater healthcare needs and mental health concerns, and depend on community-based services for support. Prior to the COVID-19 pandemic, adequate access to multidisciplinary diagnostic evaluations for children and adolescents with suspected developmental disorders was already problematic. This article aims to explore the impact of the policy measures in response to the COVID-19 pandemic on the accessibility, changes in working processes and action strategies after the first lockdown period. Methods A rapid response study was done after the first wave of the virus in Belgium. A questionnaire with open-ended questions was sent out to respondents of all centers for ambulatory rehabilitation, autism reference centers and centers for developmental disorders, three types of organizations identified as main providers of diagnostic evaluations for children and adolescents. Qualitative data were thematically analyzed in an iterative process including researcher triangulation. Results The response rate was 0.60. All centers reported an impact of COVID-19-related policy measures on accessibility, working processes, working practices, workload, planning, and time management, as well as on the quality of the diagnostic assessments and the contacts with clients. Suggestions to decrease the impact of the pandemic-related measures on the care trajectories of children with (suspected) developmental disorder include the definition of priority groups, a temporary increase of public financing to expand team capacity, a less rigid application of regulatory restrictions as well as a temporary assignment stop. Conclusion The impact of the COVID-19 pandemic reinforced the problem of accessibility of multidisciplinary diagnostic evaluations for children suspected of a neurodevelopmental disorder. The organization of health services should guarantee optimal care trajectories for all vulnerable children. Accessibility problems can be reduced by providing “ bridging care ”, helping children and families with needs to overcome “gaps” of care and support during waiting periods. In the long term, an in-depth exploration of mechanisms that strengthen interorganisational collaboration is required to structurally optimize the capacity and accessibility to care for children with suspected neurodevelopmental disorders.

AIM:To clarify organizational perspectives on diagnostic evaluations for children with neurodevelopmental disorders (NDD), with the goal to enhance interorganizational collaboration and improve accessibility.METHOD:Focus groups with expert stakeholders in Flanders, Belgium, were organized. Data were analyzed in a continuous, comparative method with researcher and data triangulation, and a member check validation.RESULTS:Fifty-nine people participated in six focus groups. Organizations had no shared vision on diagnostic evaluations of NDD. An interdisciplinary team approach was considered essential. All stakeholders agreed that a diagnostic evaluation is an iterative process along the trajectory of the child.INTERPRETATION:Diagnostic evaluations of NDD should be conceptualized as an integrated process of the child's care trajectory, differentiating needs-based goals in each phase, and requiring an interdisciplinary team approach. This conceptualization will support a health systems model, allowing interorganizational collaboration to optimize available capacity and increase accessibility.

Appropriate care delivery for patients with severe mental illness (SMI) requires a high level of collaboration quality between primary, mental health, and social care services. Few studies have addressed the interpersonal and inter-organizational components of collaboration within one unique study setting and it is unclear how these components contribute to overall collaboration quality. Using a comprehensive model that includes ten key indicators of collaboration in relation to both components, we evaluated how interpersonal and inter-organizational collaboration quality were associated in 19 networks that included 994 services across Belgium. Interpersonal collaboration was significantly higher than inter-organizational collaboration. Despite the internal consistency of the model, analysis showed that respondents perceived a conflict between client-centered care and leadership in the network. Our results reveal two approaches to collaborative service networks, one relying on interpersonal interactions and driven by client needs and another based on formalization and driven by governance procedures. The results reflect a lack of strategy on the part of network leaders for supporting client-centered care and hence, the persistence of the high level of fragmentation that networks were expected to address. Policy-makers should pay more attention to network formalization and governance mechanisms with a view to achieving effective client-centered outcomes.

Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.

Abstract Background Neurodevelopmental disorders start in early childhood and may restrict personal, scholastic, social and professional development and functioning. Early detection and smooth trajectories of diagnostics, rehabilitation and support affect the child's development and opportunities. A specialized multidisciplinary team must do a diagnostic evaluation. While accessibility to multidisciplinary diagnostics for all children in Flanders (Belgium) is problematic in regular times, the lockdown measures taken by the end of March 2020 in response to the SARS-CoV-2 pandemic could amplify this problem. This article aims to explore the impact of lockdown policy measures on the accessibility of multidisciplinary diagnostics of developmental disorders.Methods This “rapid response” study was commissioned by the Flemish authorities, as a follow up of a broader study on accessibility of multidisciplinary diagnostics. A questionnaire with open-ended questions was sent out to respondents of three key types of facilities: the Centers for Ambulatory Rehabilitation, Autism Reference Centers and Centers for Developmental Disorders. Qualitative data were thematically analyzed in an iterative process by researcher triangulation.Results Measures taken in response to the SARS-CoV-2 pandemic negatively impacted on waiting periods which lengthened with at least three months and even longer for certain target groups. Specific guidelines to minimize the risk of virus contamination, impact on planning, time management and the quality of the diagnostic assessments. Respondents reported them as being time consuming, uncomfortable, with an increasing workload and leading to a reduction in the number of daily diagnostic activities. Suggested catching-up strategies were increase of public funding, a less rigid application of regulations and a complete or partial assignment stop.Conclusion The SARS-CoV-2 pandemic reinforced the existing problem of accessibility because of a general shortage of diagnostic capacity. On a shorter term accessibility problems can be tempered by providing “bridging care” during waiting periods. On the longer term, strengthening regional interorganisational collaboration is required, to enhance more efficient and effective diagnostic trajectories in facilities providing adapted services to the needs of the children.

Abstract Background 20% of all children suffer a neurodevelopmental disorder (NDD) worldwide. Each child with a (suspected) NDD should have access to a specialised multidisciplinary diagnostic setting to pass a qualitative and adequate diagnostic trajectory. In Flanders, Belgium, 6 types of public organisations offer multidisciplinary diagnostics of NDD for children. However the objective of timely diagnostics for the population is not realized. Methods Literature review, document- and website analysis, surveys and focus groups were done. Results of the surveys have been analysed by SPSS, focus groups have been thematically analysed by a process of data- and researchers triangulation. Results were discussed and validated by experts in focus groups. Results The response on the survey was 155. 67 surveys were included for analysis. 71 professionals participated in a focus group. As a result of an historical dispersed development, the field of organisations offering diagnostics of NDD in Flanders is heterogeneous. Diagnostics are provided in each region, but not in every region the same competences, knowledge, expertise and capacity are available. Overall it lacks sufficient capacity. The accessibility, nature of the diagnostics, target groups, composition of the diagnostic teams and working processes differ between organisations and are not coordinated. There is no shared interorganisational opinion on the concept and content of diagnostics. An important hampering factor for interorganisational collaboration is the lack of trust in the quality of diagnostics by other organisations. Many ruptures in the overall trajectory hamper continuity of care for NDD. Conclusions Besides creating more diagnostic capacity according to a geographical planning, interorganisational collaboration will tackle the accessibility problem. A coordinated common framework grounded in the logics of cooperation and collaboration of a heterogeneous mix of organisations providing diagnostics, is needed. Key messages Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDD. A shared interorganisational opinion on the concept and content of diagnostics aiming to improve interorganisational trust in the quality of diagnostics, must be developed.