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UKONS Position Statement on MDT Reform

17 May 2019

The UKONS board recognises that Multi- Disciplinary Team (MDT) working is a valuable and important element of Cancer Care in the UK. We also recognise that the system is no longersustainable in its current format whereby all patients with a cancer diagnosis are ‘discussed’ initiallyand at various points in their treatment pathway, resulting in a treatment plan being formulated and approved. There are substantial pressures on the MDT system including increasing numbers of patients and manpower challenges with shortages of radiologists, pathologists and oncologists. Prior to his death Professor Martin Gore had initiated a national project to streamline the MDT process. This project is now approaching its final phases. UKONS were asked to contribute to the debate and to assist with the process of finalising guidelines and putting them into action. We have produced a position statement which, we hope, represents the views of cancer nurses; ensuring they continue to have an important voice in MDT discussions, as the patients advocate and ensuring the patients voice and wishes are heard and ultimately protecting the interest of patients. Our position statement is as follows:

• UKONS would support continuation of the central role of site-specific MDT meetings and the MDT process in determining the best evidence-based individual plan of care for patients with cancer. We would not wish to return to the time when treatment plans were based on the preferences of individual clinicians

• UKONS recognises that the MDT system is not sustainable in its current format and we wouldsupport a reduction in the numbers and types of patients discussed at MDT. This reduction should be based upon stratifying patients to remove those from the MDT whose cancer has been rigorouslyassessed as being suitable for a ‘protocolised’ approach. Currently, many MDTs do not have the time per patient for nurses to contribute to a balanced discussion on the treatment options available to patients. This process would however not remove the opportunity for professionals to communicate, outside of the formal MDT setting

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• UKONS believes that the MDT should also concern itself with identifying patients who might beappropriate for clinical trials and support the nurse’s role and involvement in these discussions

• UKONS believes that site-specific specialist nurses should remain involved as core-members of the MDT meeting, as they have the potential bring a unique patient-centred view to discussions. We also realise that this can only be relevant if a patient has contact with the CNS team prior to an MDT meeting. We recommend that this contact is standardised by using a structured, holistic needs assessment

• UKONS would also like research outcomes to be considered as these suggest that many specialistnurses do not feel able to contribute to MDT discussions. UKONS advocates the development of a less hierarchical approach to MDT meetings, whereby the whole team has opportunity to contribute to discussions and decision-making

• UKONS would like to be involved in either developing, or improving access to, existing educationprogrammes that support specialist cancer nurses in increasing their contribution to MDT discussions.

It would be both helpful and valuable to continue to capture the views of our membership on this important issue and any opinions or thoughts should be addressed to Mark Foulkes HERE.