Download Improving Midland Cancer Multidisciplinary Meetings Action Plan

Improving Midland Cancer
Multidisciplinary Meetings
Action Plan
2016
Table of Contents
1 Executive summary..................................................................................................... 3
2 Introduction ................................................................................................................. 5
3 Background ................................................................................................................. 6
4 Summary of progress against 2015 action plan ....................................................... 6
5 The Way Forward – Midland Cancer MDM Action Plan 2016.................................... 9
6 Summary proposed expenditure for July 2015 – June 2016 .................................. 10
7 Conclusion ................................................................................................................ 10
Appendix 1: Current cancer multidisciplinary meetings ............................................... 11
Appendix 2: VC connectivity ........................................................................................... 12
Appendix 3: National tumour standards – summary of MDM requirements ................ 13
2
1 Executive summary
Cancer MDMs are a deliberate, regular, face-to-face (or videoconference) meeting to facilitate
prospective multidisciplinary discussion of options for patients’ treatment and care. Prospective
treatment and care planning refers to making recommendations in real time, with an initial focus on
the patient’s primary treatment. These recommendations can only be as good as the information
available to the range of specialists (surgeons, radiologists, pathologists, medical and radiation
oncologists etc.) at the meeting. The final decision on the treatment is made by the patient in
discussion with their lead clinician.
Improving cancer multidisciplinary meetings is a national priority contributing to the achievement of
the faster cancer treatment health target, faster cancer treatment wait times, achievement of national
tumour standards and improved patient outcomes. The Ministry of Health published the national
guidance document Achieving best practice cancer care: Guidance for implementing quality
multidisciplinary meetings (MDM Guidance) in 2012 to inform DHB best practice related to MDMs.
In 2012-13 the Ministry of Health directed that pharmacy savings ($2m by PBFF to DHBs) be utilised
for the establishment of MDMs for all cancer types and increasing the number of cases discussed at
MDMs.
Midland funding allocation
Bay of Plenty: $110,207.51
Lakes: $50,301.28
Total: $359,719.07pa
Waikato: $173,617.82
Tairawhiti: $25,592.46
This funding builds on prior investment by the Ministry of Health and regional cancer networks. In
2015-16 DHBs are required to report six monthly on the expenditure of these funds and progress
against this regional action plan.
Phase 2 of the national tumour standards work programme was to include the development of tumour
stream data sets and prioritisation criteria for discussion of patients at cancer multidisciplinary
meetings by December 2015. As at December 2015 the data sets have not been published and the
MDM prioritisation criteria development has been put on hold.
The NZ Cancer Health Information Strategy has been developed and under this programme there is
a national MDM Project in 2016. The project team will work with the DHBs and Regional Cancer
Networks (RCNs) to develop national data, business and system requirements and business
processes. The development of standardised national MDM requirements and business processes
will provide the framework to support the move to a national MDM model and improve functionality,
information quality to support clinicians, patients and service delivery reporting.
What we have achieved

Waikato now has a room set-up specifically for video conferencing with Auckland MDMs (2
landscape monitors).

Bay of Plenty lung cancer MDM commenced in September 2015

Bay of Plenty Urology MDM is now held on the first and third Tuesdays of the month with
Waikato oncologists video conferencing in to participate in the discussion of Lakes patients
from 1 March 2016

Lakes Breast Cancer MDM continues with participation by Waikato-based oncologists and
surgeon via video conferencing.

Implementation of video conferencing for clinicians to participate in regional cancer MDMs
and for Waikato specialists to participate in local MDMs; Tairawhiti surgeons connect into the
Waikato Breast, Melanoma (as required), LGI and UGI Oncology MDMs; Whakatane
surgeons connect to the Bay of Plenty Breast and Surgery Pathology MDMs; Bay of Plenty
clinicians connect to the regional Lymphoma MDM, Head and Neck MDM and Chest
3
Conference; Lakes clinicians connect to the LGI Oncology MDM, Chest Conference and as
required Melanoma MDM.

Midland clinicians have been connecting to the Auckland Gynaecological and CMDHB
Sarcoma MDMs.

Video conference connectivity with associated audio visual equipment is located in the
Waikato, Tauranga, Rotorua and Whakatane radiology conference rooms, Thames, L4
Meade Clinical Centre and Waiora L2 at Waikato and more recently, the Kathleen Kilgour
Centre.

Enhanced regional lung cancer eMDM proforma and database aligned to the National Lung
Cancer Standards and data set (draft).

Employment of MDM coordinators at Waikato, Lakes and Bay of Plenty DHBs to support the
administration of cancer MDMs.

Development of agenda, proformas and terms of reference for an increasing number of
MDMs to comply with the national guidance.

Improved data capture related to MDMs.
What we need to focus on

Information systems as an enabler for an MDM management system and an MDM data
repository which allows data to be available for audit and clinical decision making. Budget
Bid 2014 signalled the development of regional clinical data repositories but these have not
eventuated. While there is a national MDM project commencing in 2016 there is little
understanding of the implications for DHBs or financials. There are no current local or
regional plans or capital for MDM-related IS development in Midland.

At Waikato the Meade L4 meeting room hosts the regional Head and Neck MDM utilising
equipment that was not designed for hosting a MDM via video conference. VC participants
are not able to see pathology and at times there is difficulty with audio – an additional table
microphone has been purchased. Consideration was given to upgrading equipment to same
standard as the Radiology conference Room but room pillars create difficulty with this. In
2017-18 Waiora L4 meeting room may become available for MDMs and other users and with
the addition of a microscope and camera and ceiling microphones would be an ideal venue
for larger MDMs such as Head and Neck and Waikato Breast. However there will be
demand from other non-cancer clinical meetings for this room at peak times.

Completion/review of MDM terms of reference. Responsibility was assigned to MDM Chairs,
MDM Coordinators and clinical nurse specialists. Most have experienced competing
priorities and terms of reference were not considered a high priority despite a generic
template being available in the MDM Guidance document.

The diversity in source information systems in Midland DHBs means there is currently little
opportunity for integration to support development and implementation of eProformas and
associated databases or MDM management systems to reduce the administrative workload.

Only two MDMs (Chest Conference and Head and Neck) have an associated database able
to be populated by data download from the eProforma. The Neurosurgery MDM has an
associated database. Waikato is implementing a Dendrite database for surgical clinical audit
and this has been demonstrated to other Midland DHBs. It is yet to be determined whether
this will collect a full data set for tumour streams such as colorectal, or utilised only for
surgical audit.

Development of proformas and eProformas. While work has occurred at Bay of Plenty to
develop these for Breast and Surgery Pathology MDMs, there is reluctance to use them at
some MDMs due to administrative burden. At Waikato a Breast proforma is now in use for
oncology cases. Otherwise breast proformas are completed by hand at the Breast MDMs
prior to uploading into clinical workstation.
4

There continues to be resource constraints include shortage of specialists to prepare for and
participate in cancer MDMs especially pathologists and radiologists particularly at peak
holiday and conference times.

Ensuring patients from Hauora Tairawhiti have access to a Genito-urinary or Urology
Oncology MDM. Currently there is only radiology and pathology support available for the
fortnightly Genito-urinary MDM at Waikato.
The focus of the 2016 Midland MDM Action Plan includes:

audit of MDMs against the relevant tumour stream standard and/or the national Guidance

requirement for all cancer MDMs to comply all aspects of the national guidance and with
requirements in the recently published national tumour standards

investigating information systems solutions for MDM database/data repository and meeting
management requirements and keeping a watching brief on the outcomes of the NZ Cancer
Information Strategy MDM project.

review of audio-visual equipment in radiology conference rooms which has now been in
place for 3 years; and video conferencing in place for nearly 3 years. DHBs are encouraged
update technology/equipment that is no longer supported by manufacturers

implementation of processes to ensure Tairawhiti patients are discussed at Waikato urology
MDMs.
2 Introduction
The Midland Cancer Network has updated the 2014-15 gap analysis for cancer multidisciplinary
meetings and is continuing a regional approach to the improvement of these meetings on behalf of
Midland Cancer Network DHBs. Regional oversight and leadership is critical for the implementation
of consistent best practice cancer MDMs across Midland supporting the Faster Cancer Treatment
work programme and ensuring better outcomes for those diagnosed with cancer.
Cancer MDMs are a deliberate, regular, face-to-face (or videoconference) meeting to facilitate
prospective multidisciplinary discussion of options for patients’ treatment and care. Prospective
treatment and care planning refers to making recommendations in real time, with an initial focus on
the patient’s primary treatment. These recommendations can only be as good as the information
available to the range of specialists (surgeons, radiologists, pathologists, medical and radiation
oncologists etc.) at the meeting. The final decision on the treatment is made by the patient in
discussion with their lead clinician.
Implementing quality cancer MDMs supports the faster cancer treatment programme. In October
2012 an updated guidance document Achieving best practice cancer care: Guidance for
implementing quality multidisciplinary meetings (MDM Guidance) was released by the Ministry of
Health to inform DHB best practice related to MDMs http://www.health.govt.nz/publication/guidanceimplementing-high-quality-multidisciplinary-meetings.
Phase 2 of the national tumour standards work programme was to have included the development of
tumour stream data sets and prioritisation criteria for discussion of patients at cancer multidisciplinary
meetings (December 2015). However these have not been progressed nationally.
The Midland Cancer Network has updated the 2015 gap analysis for cancer multidisciplinary
meetings and is continuing a regional approach to the improvement of these meetings on behalf of
Midland Cancer Network DHBs. Regional oversight and leadership is critical for the implementation
of consistent best practice cancer MDMs across Midland supporting the Faster Cancer Treatment
work programme and ensuring better outcomes for those diagnosed with cancer.
5
3 Background
Midland Cancer Network priority 2011-12
The network has had improving cancer MDMs as a priority since 2009-10. In 2011-12 the network
prioritised one-off Ministry of Health funding ($200,000) for improving cancer MDMs with agreement
for upgrading audiovisual equipment to high definition (HD) in radiology conference rooms at
Rotorua, Tauranga and Waikato hospitals. This was to enable best practice local meetings where
radiology, pathology, summary of clinical information for each patient (proforma) could be viewed
simultaneously providing high quality information for discussion by clinicians. It was also preparation
for connecting the three rooms by video conferencing which would allow clinicians to participate in
regional meetings and supra-regional meetings as well as for Waikato oncologists to participate in
Bay of Plenty and Lakes MDMs. All audiovisual upgrades were completed by 1 September 2012.
The Tauranga Hospital upgrade was completed in December 2011. At that time Tairawhiti DHB
participated in the Central Cancer Network MDM project.
Sustainable funding from 2012-13
To support achievement of Faster Cancer Treatment indicators the Ministry of Health directed that
pharmacy savings ($2m by PBFF to DHBs) be utilised for the establishment of MDMs for all cancer
types and increasing the number of cases discussed at MDMs. MDMs are an essential component
of care pathways supporting DHBs to meet the Faster Cancer Treatment wait time indicators.
Midland funding allocation
Bay of Plenty: $110,207.51
Lakes: $50,301.28
Total: $359,719.07pa
Waikato: $173,617.82
Tairawhiti: $25,592.46
The Ministry of Health advised that the funding was to be used for additional MDM activity including:
 MDM coordination roles
 increasing MDM connectivity
 reviewing existing MDMs and streamlining processes so more cases are discussed
 implementing MDMs across all main tumour types
 implementing electronic clinical agendas and forms across all MDMs
 implementing information system and data collection for MDM monitoring and audit across all
MDMs.
As in previous years Midland Cancer Network has facilitated the implementation of regional priorities
outlined in the annual Midland MDM action plans. PP24 reporting is six monthly in 2015-16.
4 Summary of progress against 2015 action plan
The table below outlines progress on achievement of the actions as outlined in the plan.
Action
When
Who leads
Progress
1. Each MDM must have a
designated Chair and
deputy
June 2015
2. Each MDM must have a
terms of reference agreed
and signed off
March 2015
MDM Chair
Midland
Cancer
Network
project
manager/Clinical
Director
MDM Chair
Midland
Cancer
Network
project
manager/Clinical
Director
Completed.
All MDMs have a designated
Chair
Partially completed.
Waikato
Gynae-Oncology
MDM and Upper Gastrointestinal MDM, Bay of Plenty
Surgery Pathology and Urology
Oncology MDMs, Waikato
Urology Oncology and Genitourinary MDMs now have terms
of reference. See table 2 for
6
Action
When
Who leads
3. Implement MDM
recommendations from
regional lung cancer review
including revision of terms of
reference to incorporate
provisional prioritisation
criteria
4. Implement MDM
recommendations from
regional bowel cancer
review including:
 Terms of reference
 Proforma changes
March 2015
Chest Conference
Chair
Midland
Cancer
Network
project
manager
Assistant
GM
Internal Medicine
MDM Chair
Midland
Cancer
Network
project
manager
5. Implement MDM
recommendations from
regional gynaecological
cancer review and Midland
Gynae-oncology model of
service improvement project
6. Midland DHBs connect to
Auckland Gynae-Oncology
MDM:
 Agree time for all
including
oncologists
 Identify VC
endpoints
7. Waikato Breast MDM to
implement MDM proforma
for oncology cases
June 2015
8. Ensure all proformas
clearly state who will
communicate the
recommendation to the
patient and how.
9. Develop intranet resource
for cancer MDMs to outline
schedule at each DHB: day,
time, agenda cut-off, MDM
coordinator contact details,
cancer nurse specialist
contact details, referral
process, proformas and/or
registration process.
10. Implement tumour
standard guidance for
MDMs – See Appendix 3
June 2015
11. Identify appropriate
facilities for Urology and
Colorectal Pathology MDMs
March 2015
June 2015
January
2015
June 2015
March 2015
Progress
MDM Chair
Midland
Cancer
Network
project
manager
Waikato
Clinical
Director
Midland
Cancer
Network
Project
Manager
MDM Coordinators
MDM Chair
Midland
Cancer
Network
project
manager
Midland
Cancer
Network
Project
Manager
MDM Chairs
MDM Coordinators
Midland
Cancer
Network
Project
Manager
MDM Coordinators
further information.
Completed.
Partially completed.
Bay of Plenty: Number of
patients referred/registered to
MDM is recorded – ongoing
Tairawhiti: Referral system in
place.
Waikato: Separation of Upper
and Lower GI MDMs – Lower
GI terms of reference to be
updated.
Completed.
Waikato: Terms of Reference
completed; Chair confirmed.
Completed.
Completed.
Proforma in use for oncology
cases.
Completed at Waikato.
BOPDHB has developed an
intranet
resource
and
a
schedule of MDMs is included.
MDM Guidance now on
Waikato intranet as part of FCT
resources.
December
2015
MDM Chairs
Midland
Network
Manager
Midland
Network
Manager
Cancer
Project
Cancer
Project
In progress - aligned with
tumour standard reviews.
Completed
7
Action
When
Who leads
To
be
determined
Midland
Network
Manager
Cancer
Project
13. Identify training needs
for successful use of video
conferencing for MDMs
including VC etiquette
14. Review MDM database
requirements for audit and
implement
recommendations. Support
development of national
tumour stream data sets and
implement once approved
15. Support development of
prioritisation criteria for
tumour stream MDMs and
implement
Ongoing
Midland
Network
Manager
Cancer
Project
Ongoing
Midland
Cancer
Network
Manager
and
Project
Manager
MDM Chairs and
specialists
Database in place for lung
cancer and implemented June
2015 for Head and Neck MDM.
On hold nationally.
16 Ensure all MDMs have
appropriate representation
from all required disciplines
including medical and
radiation oncologists
17. Continue development
of MDM proformas and
eProformas
Ongoing
Midland
Cancer
Network Manager,
Midland clinical work
group chairs
MDM Chairs
DHBs and MDM
Chairs
Ongoing
Midland
Cancer
Network
Project
Manager
MDM coordinators
18. Appoint MDM
Coordinator at Tairawhiti
19. Implement process for
Tairawhiti breast pathology
slides to be shown at MDM TLab (Medlab Central)
March 2015
Clinical
Nurse
Manager
Midland
Cancer
Network
Project
Manager
MDM coordinators
Tairawhiti
20. Planning and Funding to
work with urology providers
to ensure future MDM data
To
be
determined
Partially completed.
Word-based Breast proforma
now in use at Waikato. Bay of
Plenty has developed some
MDM proformas but not all in
use at meetings given lack of
resource to complete. Bay of
Plenty lung cancer MDM using
regional Chest Conference
proforma.
Bay of Plenty
Urology Oncology MDM using
electronic proforma.
Completed.
In place until 30 June 2015.
Partially completed.
Discussion with TDH and
Medlab. PN pathologist unable
to VC into MDM. Tairawhiti
surgeons to discuss any
queries
with
pathologist
concerned
Meeting at end of March
following
Midland
Cancer
Network Executive Group to
at Waikato and implement
12. Investigate options to
ensure Lakes and Tairawhiti
patients have access to a
Genito-urinary MDM
When
developed
March 2015
P&F
Progress
Partially completed. Bay of
Plenty Urology Oncology MDM
now held fortnightly rather than
monthly.
Lakes patients to be discussed
at the BOP MDM with
participation from Waikato
oncologists from 1 March.
Waikato Urology Oncology and
Genito-urinary MDMs held
alternate weeks.
Ongoing.
Tumour stream data sets not
yet available.
Completed.
8
Action
When
Who leads
requirements are included in
contracts.
Progress
discuss additional clauses for
urology contracts.
Venturo contract completed.
Urology
Services
Limited
negotiations continue.
Additional
In early 2015 Midland Cancer Network worked with KKC and their video conferencing provider to
enable their participation in Midland MDMs.
5 The Way Forward – Midland Cancer MDM Action Plan
2016
Assumptions
 There is no additional oncology, radiology or pathology resource available.
 Hauora Tairawhiti cancer patients are to be included in all Waikato or regional MDMs.
Action Plan 2016
Action
When
Who leads
1. Participate in national MDM project
which is part of the NZ Cancer Health
Information Strategy programme of work
2. Audit of MDMs in 2016 against MDM
cluster in each of the tumour standards.
For those MDMs where there is no tumour
standard, audit will be against the 2012
MDM Guidance document..
3. Each MDM must have a terms of
reference agreed and signed off
2016
Ministry of Health
June 2016
Midland Cancer Network
March 2015
4. Tairawhiti - $14, 900 to support
additional administration FTE of 0.4 FTE
for 12 months.
This additional FTE will complete a piece of
work around current practices and then
support alignment and standardisation of
processes from referral through to MDM
and ensuring feedback from MDMs is
received and acknowledged by clinicians.
5. Maintain watching brief on data required
for MDM in National Patient Flow
6. Waikato – additional infrastructure
required in Waiora L4 meeting room if
Breast and Head and Neck MDMs move
there from 2017-18 (microscope and ceiling
microphones)
7. Waikato Breast MDM to review
implementation of MDM proforma for
oncology cases. Consider use of same
proforma in Lakes and Bay of Plenty
8. Investigate options to ensure Tairawhiti
patients have access to a Urology
Oncology or Genito-urinary MDM including
June 2016
MDM Chair
Midland Cancer Network
project
manager/Clinical
Director
Debbie Barrow, Hauora
Tairawhiti
Ongoing
Midland Cancer Network
December 2016
Waikato DHB
June 2016
MDM Chair
Midland Cancer
project manager
December 2016
Midland Cancer
Project Manager
Network
Network
9
Action
When
Who leads
increased radiology and pathology
availability at Waikato.
Tairawhiti urologist not always available to
present cases
9. Investigate options for collation of MDM
data for clinical audit and clinical decision
making
10. Continue review and development of
MDM proformas and eProformas
Ongoing
Midland Cancer Network
Manager
and
Project
Manager
Midland Cancer Network
Project Manager
MDM coordinators
Midland Cancer Network
and Sarcoma MDM
11. Ensure there are clear pathways and
guidance for clinicians referring patients to
the national Sarcoma MDM at CMDHB.
12. Stocktake of palliative care participation
in cancer MDMs
Ongoing
June 2016
June 2016
Midland Cancer Network
6 Summary proposed expenditure for July 2015 – June
2016
Allocation of funding for cancer MDMs across Midland Cancer Network DHBs in 2015-16
MDM required spend
Audiovisual support contract
Datacom VC support
MDM Coordinator
Spark MDM VC endpoint
Corporate overheads (20%)
Depreciation
Support for MDMs
Proforma development
Maintenance
Upgrades to MDM room equipment
Total
Data entry lung cancer database 0.2FTE @$50k
Contingency for unplanned maintenance
Total
Underspend/overspend
Bay of Plenty
Lakes
110,207.51 50,748.68
9,780 6,180.00
7,420.59 2,635.00
26,293 21,249.50
18,482.52 5,684.18
13,782.00 15,000.00
15,761.40
7,877.55
10,810.45
110,207.51
50,748.68
Tairawhiti Waikato
25,592.46 173,617.82
7,320
9,705.84
14,900
50,000
5,580
5,118 34,723.56
30,418.28
167.50
4,896.36
25,598.00 137,231.54
10,000
110,207.51 50,748.68
0.00
-
25,598
147,232
-5.54 26,386.28
7 Conclusion
While an increasing number of cancer MDMs almost meet the new Guidance requirements there are
some gaps and issues to be addressed to ensure all cancer MDMs in Midland comply. The action
plan signals the way forward utilising the MDM funding to support both one-off and ongoing initiatives
ensuring the infrastructure is in place to support best practice cancer MDMs.
Please note that the funding will not meet all MDM service requirements in particular, workforce gaps.
10
Appendix 1: Current cancer multidisciplinary meetings
DHB
Regional
or Local
Bay of Plenty DHB
Breast (weekly)
Surgical Pathology meeting
includes colorectal (weekly)
Endocrine (monthly)
LGI Oncology (weekly)
UGI Oncology
Gynae-oncology (weekly)
Head and Neck (weekly)
Lymphoma (weekly)
Melanoma (fortnightly)
Neurosurgery
Genito-urinary
Urology Oncology
(Alternate weeks)
Myeloma (Fortnightly)
Terms of
reference
√
Screening
√
Those to be
considered for
surgery discussed
with Chest
Conference
√
√
Tuesday 12.30
√
√
√
√
Local
Wednesday
13.30
√
√
√
Handwritten
Screening
√
Waikato and
Tairawhiti
Regional
Wednesday
08.30
Wednesday
10.00
Friday 12.30
Wednesday
08.00
√
√
√
√ (oncology)
Screening
√
√
√
Tuesday 08.00
BOP & Lakes
Regional
Waikato
Lakes
Tairawhiti
Waikato
Lakes
Tairawhiti
Local
Regional
Regional
Local
Regional
Local
Regional
Tuesday 13.30
Thursday 08.00
Wednesday
09.00
Monday 08.30
Thursday 10.00
Wednesday
10.00
Wednesday
15.00
√
Database
√
Urology Oncology (first and third
Tuesdays)
Lakes DHB
Breast (weekly)
√
Proforma
Wednesday
11.00
Local
Local
Chest Conference (weekly)
Full
MDT Agenda
membership
√
Lung
Waikato DHB
Breast (weekly)
VC
available
Wednesday
07.40
Wednesday
08.30
Local
–
Day/time
Handwritten
√
√
√
√
Draft
Not in use at
MDM
√
√
√
Hand written
√
√
√
√
√
√
√
√
√
√
√ (Draft)
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Appendix 2: VC connectivity
Video conferencing equipment at each site for Midland cancer MDMs
DHB
Room
Directory name
Codec
Waikato
Radiology
Conference
Room (RCR)
Meade L4
meeting room
1
Waikato DHB Hamilton
MCC L1 MDM Radiology
Cisco C90
Waikato DHB Hamilton
MCC L4 meeting room 1
Cisco
SX20
1 landscape + 1
portrait
Waiora L2
Waikato DHB Waiora L2
MDM
Waikato DHB Thames
MDM
Cisco
SX20
Cisco
SX20
2 landscape
BOPDHB.TGA.MDM_RAD
Cisco C90
2 landscape + 2
portrait
BOPDHB.WHK.MDM_RAD
Cisco C60
2 landscape + 2
portrait
Kathleen Kilgour Centre
Polycom
Group 500
Cisco C60
1 large landscape +
46” portrait
3 landscape + 1
portrait
1 landscape and 1
monitor able to be
rotated – both 50”
3 landscape monitors
in host room
Bay of
Plenty
Thames
Seminar
Room
Tauranga
RCR
Whakatane
RCR
Lakes
Rotorua RCR
Lakes DHB MDM
Tairawhiti
(Spark
Digital)
Northern
DHB VMRs
(Vivid)
Tui Te Ora
Tairawhiti DHB MDM
Cisco
SX20
Various
Gynae-Oncology MDM
Sarcoma MDM
Polycom
Monitor
configuration
(all 55” unless
specified)
2 landscape + 2
portrait
Comments
New tablet installed to replace
previous touch panel for AV/VC
November 2015
Room was not setup to host regional
MDMs by VC but for Waikato
oncologists to participate in
Lakes/BOP MDMs. Now hosts
regional MDMs but room not fit for
purpose.
Set up with2 landscape monitors for
linking into Auckland MDMs
2 landscape + 1
portrait
New tablet installed to replace
previous touch panel for AV/VC
February 2016
New tablet installed to replace
previous touch panel for AV/VC
February 2016
Codec does not have same
functionality as Cisco
AV touch panel and software no
longer supported by manufacturer
12
Appendix 3: National tumour standards – summary of MDM requirements
Tumour type
Standard
Good practice point
Breast
Standard 5.1
All women with a confirmed breast cancer
have their treatment plan discussed at an
MDM, and the outcomes of this are clearly
documented in the woman’s medical
records and communicated to the woman
and her GP.
Bowel
Standard 11
Patients with non-metastatic colon cancer
are presented in the bowel cancer MDM
5.1 Every specialist involved in breast cancer care regularly participates in a
breast MDM. For further information on expected frequency of attendance,
refer to the professional requirements section of the BreastScreen Aotearoa
National Policy & Quality Standards (NSU 2008).
5.2 The breast cancer MDT should meet weekly or at least fortnightly (NSU
2008).
5.3 The breast MDM membership should include at least the following: a
radiologist, a pathologist, oncologists – radiation and medical, breast
surgeons, a breast cancer or cancer nurse coordinator, a breast
radiographer and psychosocial service representation (as appropriate) (NHS
Quality Improvement Scotland 2008). Core members are present for the
discussion of all cases where their input is needed.
5.4 Locally agreed referral pathways clearly establish who can refer, how to
refer and the timeframes within which referrals are expected (along with
processes for late referrals) (Ministry of Health 2012d).
5.5 Treatment recommendations should be available as an electronic record
and accessible to other members of a woman’s health care team, including
her GP (expert opinion).
5.6 The MDM identifies women at high risk for inequitable care so that a
special effort can be made to avoid this outcome.
5.7 The MDM report may be used as a basis of referral to a treatment
provider, to reduce referral to treatment waiting times.
5.8 Breast cancer core data are collected prior to and during MDMs. Data
sets are consistently and routinely captured for use in clinical audit and
pathway monitoring for ongoing quality improvement.
5.9 Women are informed about the MDM’s recommendations and, in
consultation with members of the treating team, make final decisions about
their own treatment and care plan.
MDM membership
4.1 Minimum core membership of a bowel cancer MDM consists of two
surgeons, a medical and radiation oncologist, a radiologist, a pathologist, an
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within three weeks after surgery for
consideration of adjuvant therapy.
Standard 12
All patients with non-metastatic rectal
cancer or a new diagnosis of metastatic
colorectal cancer have their treatment plan
discussed at a bowel cancer MDM;
recommendations are clearly documented
in the patient’s medical records and
communicated to the patient and their GP.
Standard 13
MDMs identify patients at high risk of
receiving inequitable care, and auditable
data on these patients is collected from
them along their cancer journey.
Gynaecological
Standard 11
All women with gynaecological cancer,
borderline ovarian tumours or gestational
trophoblastic neoplasia have their treatment
plan discussed at an MDM;
recommendations are clearly documented
in the woman’s medical records and
communicated to the woman and her GP.
Standard 12
The MDM discussion takes place within 14
days of referral (provided referral criteria are
expert colonoscopist, a colorectal clinical nurse specialist, an appropriate
allied health professional and an MDM coordinator. A palliative care team
member (specialist or nurse) should be included where appropriate.
4.2 Each MDM keeps an attendance register and reviews core membership
annually to ensure members have sufficient scope in their job to adequately
contribute to their roles.
4.3 MDM outcome forms record which members of the team were present
for each case the MDM discussed.
4.4 If a core member is the sole representative of a specialty and is unable
to attend an MDM, a deputy attends in their place.
Case discussion
4.5 A patient’s MDM notes document whether the patient is potentially
eligible for clinical trials.
4.6 MDMs review patients with apparently isolated colorectal metastases to
determine their eligibility for further surgery by an MDM with the relevant
expertise (e.g. hepatobilary or thoracic).
4.7 MDMs consider preoperative or post-operative adjuvant radiotherapy for
all patients with rectal cancer (NZGG 2011b).
4.8 MDMs document distance to the circumferential margin in all cases of
rectal cancer. Post-operatively, the same rectal cancer MDM that determined
the preoperative therapy discusses those patients with a histologically
involved (<2 mm) circumferential margin.
4.9 For patients in whom rectal cancer recurs locally, the same MDM that
determined the preoperative therapy discusses the case post-operatively.
4.10 MDMs discuss and record comorbidities.
4.11 MDMs record family history of bowel cancer.
4.12 Public hospital MDMs may discuss private and public patients.
4.1 A comprehensively staffed gynaecological MDM includes, at minimum: a
gynaecological oncologist, a medical oncologist, a radiation oncologist, a
radiologist, a clinical nurse specialist or care coordinator and a pathologist,
all of whom regularly attend gynaecological cancer MDMs. The referring
clinician or delegated deputy is also present, and there is an adequately
resourced dedicated MDM coordinator/data manager.
4.2 Discussion at the MDM includes:
 review of pathology by a pathologist with a special interest in
gynaecological pathology, who regularly attends the gynaecological
oncology MDM
 documentation of treatment recommendations agreed by the MDM
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met).
participants
formal allocation and documentation of staging, as per the FIGO
system
 Documentation of MDM proceedings is collected and made available
as part of a woman’s medical record.
4.3 Criteria and information requirements for referral to regional MDMs are
developed and agreed nationally.
4.4 For women with gynaecological cancer or a high clinical suspicion of
ovarian cancer, MDM review occurs prior to definitive management (unless
acute illness requires immediate intervention) and after surgery, to plan postoperative treatment.
4.5 Women are informed about MDM recommendations by an identified
clinical team member. Following consultation with members of the treating
team, women make the final decision about their treatment and care plan.
4.6 Review at MDM is considered for women with gynaecological cancer
who have recurrent disease.
4.7 Options for fertility preservation are discussed with all women of
childbearing age prior to definitive management.
4.8 Discussion between paediatric and gynaecological oncology MDMs is
appropriate for women under the age of 20 with gynaecological tumours.
4.9 Discussion between MDMs is appropriate in cases of gynaecological
melanoma, sarcoma and haematological tumours.
4.10 To ensure sustainability and contingency for absence, multiple team
members from single specialty groups attend the MDM regularly.
4.11 The MDM takes a regional team approach to use and foster regional
expertise in gynaecological pathology and radiology services.
4.12 Protocols for expedited MDM review are agreed nationally.
4.13 MDM protocols are consistent with Ministry of Health guidance for
implementing quality MDMs (Ministry of Health 2012c).
5.1 Ideally, MDMs are held weekly, or at least fortnightly, to minimise delays
in initiation of patient treatment and patient anxiety.
5.2 Treatment plans are agreed and documented prior to the initiation of
treatment, noting the reasons for any variation from standard practice. Plans
are available electronically, and are accessible to other members of the
health care team.
5.3 All referrals to a MDM include demographic data; provisional staging
information; and data on clinical factors such as current symptoms,
performance status, weight loss, medical co-morbidity and clinical findings

Head and neck
Standard 5.1
Patients diagnosed with head and neck
cancer (excluding T1, 2 N0 cutaneous) are
assessed at an MDM for staging and
treatment planning; recommendations are
clearly documented in the patient’s medical
records.
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Lung
Standard 9
All patients with lung cancer should be
discussed at a
multidisciplinary meeting. (Expert opinion)
(including through endoscopy, relevant imaging and pathological diagnosis)
to maximise the chance of making appropriate clinical decisions.
5.4 Treating clinicians record reasons for not following a treatment plan
recommended by the MDT.
5.5 Patients undergoing treatment for cancers of the oral
cavity/pharynx/larynx are assessed by a speech-language therapist and
dietitian prior to treatment.
5.6 Malnutrition screening is undertaken with a validated tool.
5.7 In order to meet Māori needs and reduce inequalities, cancer care
services are focused on Māori priorities. This may involve the reorientation of
existing services or the development of new services or initiatives, as well as
strengthening the role of effective service delivery models. Some specific
areas of good practice include:
 involving Māori expertise and the range of relevant Māori services
and providers in MDTs and networks
 prioritising Māori in the piloting of developments or initiatives in
service delivery
 developing tools (such as Whānau Ora assessments) to meet the
needs of Māori, which can be used to inform patient treatment plans
and care coordination
 involving Māori patients and their family/whānau in MDMs to discuss
treatment options and plans.
5.8 All Māori patients and their family/whānau are offered access to Whānau
Ora assessments and cultural support services.
5.1 All referrals to a multidisciplinary meeting should include demographic
data, provisional staging, and clinical factors such as: current symptoms,
performance status, weight loss, medical co-morbidity, bronchoscopy,
relevant imaging, pathological diagnosis (if available) and lung function to
maximise the chance of making appropriate clinical decisions. (Expert
opinion)
5.2 The multidisciplinary team should record information in a database that
can be collated and analysed locally, regionally and nationally. (Expert
opinion)
5.3 The multidisciplinary discussion report should include treatment
recommendations and intent, where possible, as well as reasons for any
variation from standard practice. (Expert opinion)
5.4 The treating clinician should record the reason for not following the
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Lymphoma
Standard 4.1
All patients with confirmed lymphoma have
their treatment plan discussed at an MDM;
recommendations are clearly documented
in the patient’s medical records and
communicated to the patient, the treating
clinician and the patient’s GP within one
week.
Melanoma
Standard 5.1
Patients with the following are discussed at
an MDM:
 stage III and IV cutaneous
melanoma
 desmoplastic melanoma
treatment plan recommended by the multidisciplinary team. (Expert opinion)
5.5 Patients and their GP should be informed of the recommendations of the
multidisciplinary discussion within two working days of the meeting. (Expert
opinion)
5.6 The recommendations of the multidisciplinary discussion should be
available as an electronic record and accessible to other members of the
health care team. (Expert opinion)
4.1 MDMs are governed by agreed terms of reference, and written protocols
describe the organisation and content of the meeting.
4.2 A chair is appointed according to the terms of reference. Core members
(see Ministry of Health 2012b) are present for the discussion of all cases
where their input is needed.
4.3 Locally agreed referral pathways are established with clear information
as to who can refer, how to refer and the timeframes within which referrals
will be expected (along with processes for late referrals). Agreed criteria
determine which patients should be discussed at the MDM.
4.4 A role representing a single point of coordination for MDMs is
established, to supports clinicians participating. Treatment recommendations
agreed by participants are documented during the meeting and recorded in
patients’ medical records.
4.5 Lymphoma-specific core data is collected prior to and during the MDM.
Data sets for use in clinical audit and pathway monitoring are consistently
and routinely captured, for ongoing quality improvement.
4.6 Patients are informed about the MDM prior to the presentation of their
case. They are then informed about the MDM’s recommendations and, in
consultation with members of the treating team, make their own final
decisions about their treatment and care plan.
4.7 Established processes govern communication of recommendations to
patients, GPs and clinical teams within locally agreed timeframes. The MDM
identifies a lead clinical team member to discuss the MDM’s
recommendations with the patient.
5.1 Minimum core membership of a melanoma MDM consists of a general
surgeon and/or plastic surgeon, a pathologist, a radiation oncologist, a
medical oncologist, a radiologist and a clinical nurse specialist. Other MDT
members may be involved, including dermatologists, GPs, adolescent and
young adult key workers and palliative care team members.
5.2 The melanoma MDM process within each hospital and region is
documented, including: appointment of MDM members, referral pathways,
17
 melanoma under 18 years of age
 non-cutaneous melanoma
The outcome of the MDM is documented
and communicated to the treating clinician,
GP and patient within one week.
Myeloma
Standard 4.1
All patients diagnosed with myeloma have
their treatment plan discussed at an MDM;
recommendations are clearly documented
in the patient’s medical records and
communicated to the patient, the treating
clinician and the patient’s GP within one
week.
meeting frequency and videoconferencing links between regional and
provincial hospitals, where appropriate.
5.3 Details of patients discussed at the MDM are recorded on a standardised
MDM template.
5.4 A dedicated clinical nurse specialist or other health professional is
appointed to coordinate written and verbal communication (including use of
a dedicated melanoma MDM referral proforma).
5.5 Adequate support staff and resources are available to the MDM. Smaller
provincial MDTs or treating clinicians present patients to regional MDMs in
person or via teleconferencing.
5.6 The MDM records and discusses patients with stage Ib melanoma and
above if required.
5.7 The MDM records information in a database that can be collated and
analysed locally, regionally and nationally.
5.8 Treating clinicians record reasons for not following treatment plans
recommended by the MDM.
5.9 Recommendations from MDM discussions are available as an electronic
record and accessible to other members of a patient’s health care team.
5.10 All Māori patients and their family/whānau are offered an opportunity to
access Whānau Ora assessments and cultural support services.
4.1 MDMs are governed by agreed terms of reference, and written protocols
describe the organisation and content of the meeting.
4.2 A chair is appointed according to the terms of reference. Core members
(see Ministry of Health 2012a) are present for the discussion of all cases
where their input is needed.
4.3 Locally agreed referral pathways are established with clear information
as to who can refer, how to refer and the timeframes within which referrals
will be expected (along with processes for late referrals). Agreed criteria
determine which patients are discussed at the MDM.
4.4 A role representing a single point of coordination for MDMs is
established, to support clinicians participating. Treatment recommendations
agreed by participants are documented during the meeting and recorded in
patients’ medical records.
4.5 Myeloma-specific core data are collected prior to and during the MDM.
Data sets for use in clinical audit and pathway monitoring are consistently
and routinely captured, for ongoing quality improvement.
4.6 Patients are informed about the MDM prior to the presentation of their
case. They are then informed about the MDM’s recommendations and, in
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Sarcoma
Standard 4.1
All patients with the following confirmed
sarcomas are presented at a sarcoma
MDM:
 bone sarcoma
 soft tissue sarcoma of extremities,
trunk and retroperitoneum.
consultation with members of the treating team, make their own final
decisions about their treatment and care plan.
4.10 Established processes govern communication of recommendations to
patients, GPs and clinical teams within locally agreed timeframes. The MDM
identifies a lead clinical team member to discuss the MDM’s
recommendations with the patient.
4.1 Core membership of a sarcoma MDT ideally includes the following: a
specialist sarcoma radiologist, a specialist sarcoma pathologist, a specialist
sarcoma surgeon, a radiation oncologist, a medical oncologist, a palliative
care specialist and a clinical nurse specialist/cancer nurse. Paediatric
oncologists, AYA key workers and allied health practitioners such as a
physiotherapists, orthotists, psychologists and occupational therapists may
also be involved.
4.2 The agreed terms of reference governing the MDM are based on Ministry
of Health guidance (2012a), and include written protocols that describe the
organisation and content of the meeting, including agreed criteria outlining
which patients should and should not be discussed.
4.3 Hospitals support members of the MDT to attend MDMs either virtually or
physically.
4.4 The MDT records information in a database that can be collated and
analysed locally, regionally and nationally.
4.5 One national sarcoma MDM is held every week, with core members of
the sarcoma MDT present either in person or via videoconferencing facilities
where their input is required (expert opinion).
4.6 Patients and their GPs receive the MDT’s recommendations on
diagnosis, treatment options and treatment care plans in writing within two
working days of the MDM.
4.7 Final decisions on treatment and care plans are made by patients and
their family/whānau, in consultation with members of the treating team
(expert opinion).
4.8 Treating clinicians record reasons for not following a treatment plan
recommended by the MDT (expert opinion).
4.9 A clear pathway exists for patients with a sarcoma who require
management under a site-specific MDT (such as those for head and neck,
gastrointestinal stromal, gynaecological or skin cancers) or paediatric
services (NCCN 2012a).
4.10 Specific cultural services and expertise are involved through the MDT
where appropriate.
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Thyroid
Standard 5.1
Patients with the following are discussed at
an MDM:
 differentiated thyroid cancer greater
than a micro carcinoma (>1 cm in
diameter) or any size cancer with
adverse histology (e.g., medullary,
anaplastic)
 a preoperative diagnosis of thyroid
cancer with suspicion of
extrathyroidal invasion or
lymphadenopathy
 recurrent thyroid cancer
 metastatic thyroid cancer.
4.11 Multidisciplinary meetings formally audit their operations and review
complications outside the routine MDM at regular intervals, as deemed
appropriate by the members of the group.
5.1 Most patients with thyroid cancer are discussed at an MDM.
5.2 One clearly identified lead clinician is responsible for coordinating patient
care.
5.3 The core membership of a thyroid MDM includes:
 an endocrinologist
 a thyroid surgeon
 a radiologist
 specialist pathologists (histopathology and cytopathology)
 a clinical nurse specialist or team care coordinator/data clerk
 at least one team member trained and licensed to give radioactive
iodine (a nuclear medicine physician, a radiation oncologist or a
radiologist).
5.4 The MDT has contact with and appropriate access to the following
support services:
 FNA cytology
 flexible laryngoscopy
 radiation oncology
 medical oncology
 clinical genetics
 clinical biochemistry
 adolescent and young adult services
 psychology/social work.
5.5 Smaller provincial MDTs or treating clinicians from smaller centres aim to
present patients to their regional MDT in person, via teleconferencing or via
email discussion (i.e., to attend a ‘virtual MDM’).
5.6 Meeting frequency is dictated by patient numbers.
5.7 The multidisciplinary discussion report includes treatment
recommendations and intent where possible, as well as reasons for any
variation from standard practice.
5.8 Treating clinicians record reasons for not following treatment plans
recommended by the MDM.
5.9 Patients and their GPs are informed of the MDM’s recommendations
within seven days of the meeting.
5.10 Recommendations of the MDM are available as an electronic record,
20
and accessible to other members of the health care team.
5.11 The MDT records information in a database that can be collated and
analysed locally, regionally and nationally.
5.12 An electronic MDM reporting system is developed and available online,
for uniform recording of information at a national level.
5.13 In order to meet Māori needs and reduce inequalities, cancer care
services are focused on Māori priorities. This may involve the reorientation of
existing services or the development of new services or initiatives. Some
specific areas of good practice include:
 involving Māori expertise and the range of relevant Māori services
and providers in MDTs and networks
 prioritising Māori in the piloting of developments or initiatives in
service delivery
 developing tools (such as Whānau Ora assessments) to meet the
needs of Māori, which can be used to inform patient treatment plans
and care coordination
 involving Māori patients and their family/whānau in MDMs to discuss
treatment options and plans
 offering all Māori patients and their family/whānau access to
Whānau Ora assessments and cultural support services.
Upper gastrointestinal
Standard 5.1
All patients with the following are presented
at an MDM:
 a confirmed diagnosis of HBP/upper
GI cancer
 a high suspicion of HBP/upper GI
cancer.
5.1 Agreed terms of reference govern MDMs, based on Ministry of Health
guidelines (Ministry of Health 2012b); these include written protocols that
describe the conduct and content of the meeting, including criteria outlining
which patients should be discussed.
5.2 A designated chairperson guides discussion and encourages consensus
within the MDM.
5.3 Each case is presented by the referring doctor or designee, unless the
patient has already been seen by a specialist.
5.4 An optimal number of cases is discussed at each MDM.
5.5 The MDM meets weekly, and not less frequently than bimonthly.
5.6 The MDM discusses patients prior to their first cancer treatment, to
ensure they are staged appropriately and can be offered neo-adjuvant
therapy if appropriate.
21