Adding to the evidence base: cancer patients' perspectives on multidisciplinary team working: an exploratory focus group study.
The formal use of the MDT for a patient's entire spectrum of care has much importance, particularly when health care providers might make decisions without fully knowing the patient. This is a more specific and advanced use of the MDT or interprofessional team than may exist in other countries such as the U.S., where incidental communication, huddles, and interprofessional rounds are common among teams. Interestingly, in the U.S., the team function is encouraged by nurses. On clinical units or microsystems, nurses are often the organizers of the team concept and interprofessional activities that occur. The MDT, probably because of its purpose to consider the diagnosis and treatment aspects of clinical care along with the psychosocial aspects of care, is often driven by physicians, with nurses having less importance in the decision-making. However, nurses know patients better than other providers, as noted in the results of the current study (Lamb et al., 2014).
Lamb et al. (2014) evaluated this qualitative study with grounded theory methodology. By asking about the experience of working with the MDT, it has an aspect of phenomenology because it deals somewhat with the lived experience. Nevertheless, the outcome is a series of theoretical statements about patient desires while working with the MDT that will be helpful for future or refined implementation of the team.
The study (Lamb et al., 2014) offers readers an opportunity to think about focus groups, sampling and sample size, data saturation, grounded theory approach, interviews, and theme development in relation to qualitative research. All are important aspects of qualitative research and of this study, and together, seek the answers that researchers are asking.
The lack of information available about patient experiences with MDTs is strong support for the researchers to conduct this study. Knowing how patients think and feel about these teams and the potential influence of the team on their lives adds a potential dimension to the health care system in the United Kingdom that has not previously existed.
The researchers indicate that prior to patient-centered care and the MDT, treatment decisions could be made with little knowledge of the patient and minimal input from the patient. This seems to be evidenced by the minimal knowledge many patients in the study had about the MDT. Thus, the need to include the patient within the structure of the MDT became the basis for the current study and the major focus of data collection within the study.
Focus groups are excellent ways to gather data from larger numbers of participants in a more time-efficient manner (Polit & Beck, 2012], One difficulty is that all participants may not contribute everything they would like to say about their own experience. They may also not want to share personal information within a group. Conversely, they may react to what others say and express opinions different than if they were answering alone (Polit & Beck, 2012).
Interestingly, in this study, the focus groups were held on a yearly basis for three years. One might be concerned that the changes in the knowledge about the topic would occur over time and that the information obtained might not be based on the same knowledge available to the first group of participants. It might be expected that the last group would have more knowledge of MDTs and would have stronger opinions of what should occur within the team meetings. Additionally, each group was administered by different researchers, which might have influenced the data collected from the participants.
The researchers stated that data saturation was an issue. Data saturation in qualitative research is the point in collecting data that it begins to repeat itself (Polit & Beck, 2012). When that occurs, no further participants are needed. Apparently, this occurred after the third data collection period, which, as noted earlier, was two years after the first collection of data. This may be an area that the researchers will address in future research with qualitative data collection.
Semi-structured interviews as a data collection method are very appropriate. The researchers stated there was flexibility within the interview to respond to a participant. In qualitative research, this is appropriate, and often, data received is richer if the interviewer gives time and attention when a participant needs to be more descriptive than just responding to a question.
The research questions and the semi-structured interview questions were similar, if not the same. Because the researchers said that themes emerged from the literature review and led to questions, it was a bit confusing. Usually, qualitative researchers refer to themes emerging with data analysis. Then, the data are categorized according to the research questions asked or the questions from the interview, either very appropriate. Typically, analysis of a grounded theory study begins with the first participant's data. The researcher begins to cull the data for themes and then continues to do so as more participant data are available. Within each data analysis section, this reviewer wondered why the researchers did not categorize the sub-themes that were apparent and reorganize the themes accordingly (i.e., comfort level with the nurse), which was referred to within several question categories. Often, in qualitative data analysis, a theme may emerge in more than one question category.
The researchers invited individuals from two health care institutions for data collection (Polit & Beck, 2012). They did this to achieve diversity within the sample. However, from an ethnic and gender perspective, the diversity was minimal. They indicated the population types in the two institutions were different, so they may have achieved diversity in other social and economic ways.
Purposive sampling is the deliberate selection of certain participants (Bums & Grove, 2005). In the case of the current study (Lamb et al., 2014), it was done to get specific information participants would have access to or know about regarding MDTs (Burns & Grove, 2005). Typically, the sample size in a qualitative research study is small. The amount of information in a study with 15 or more participants is amazing and large, taking a significant amount of time to analyze. Thus, managing the sample size is important. The researchers indicated in the limitations that the sample size may have limited the study. From this reviewer's perspective, it likely did not. Twenty-one participants, assuming data saturation, is sufficient to achieve the information being sought.
While generalization to other populations regarding the outcomes of the current study (Lamb et al., 2014) is not possible, there is learning from the study. Whether they are called MDTs or interprofessional teams, patients want to be involved in their care. They want to be known to the practitioners and want decisions to be made on that basis. Their level of involvement may vary depending on what they can handle. However, to take responsibility for self, patients have to feel that decisions made about their care have the utmost knowledge and that people who know them are assisting them.
From an overall perspective, the conduct of the study is strong. Researchers gave attention to details of qualitative research and to the data analysis.
Application to the Evidence Base
As a Level VI on the evidence table, a reader might misinterpret the importance of the current study (Lamb et al., 2014). As mentioned earlier, there is no doubt this information contributes to the evidence base regardless of type of health care system. While without generalization capability except to the system of which it is a part, the information about teams and nurses is important.
MDTs or other interprofessional teams are up and coming. In the United Kingdom, they are formal and mandated, and making important decisions about patient diagnosis and treatment. In the U.S. and maybe other countries, they may be operating as the MDT, but it is not as formal as in the United Kingdom. The Affordable Care Act is encouraging interprofessional teams for the benefit of the patient so they receive the best possible care to maintain their health inside and outside of health care institutions.
The MDT affords learning for all interprofessional teams that will form, and the patient's perspective is a key factor. Without patient acknowledgement, consent, and agreement, the work of the team is not as valuable as when the patient's wishes are known and respected. Lamb et al. (2014) have shared many valuable lessons with the health care community with their current study. The meaning of the data for nurses is very significant. In the United Kingdom, patients believe they communicate with, are known by, and are supported by nurses differently than other members of the team. Nurses need to pay attention to this information. The value to the patient to be known to the nurses and represented by the nurse is unparalleled in importance. In practice, nurses need to understand the importance they have to patients and to respond accordingly in their practice applications of this information. Nurses need to not only continue to be the health care provider trusted by the patient, but also to advocate strongly in their solo practice as well as in teams for their patients.
Key Words: Cancer, focus group, multidisciplinary, patients, qualitative, team.
Review of: Lamb, B.W., Jalil, R.T., Shah, S., Brown, K., Allchome, R., Vincent, C., ... Sevdalis, N. (2014). Cancer patients' perspectives on multidisciplinary team working: An exploratory focus group study. Urologic Nursing, 34(2), 83-91, 102. doi:10.7257/1053-816X.2014.34.2.83
Bums, N., & Grove, S. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.). St. Louis, MO: Elsevier.
Lamb, B.W., Jalil, R.T., Shah, S., Brown, K., Allchorne, R, Vincent, C., ... Sevdalis, N. (2014). Cancer patients' perspectives on multidisciplinary team working: An exploratory focus group study. Urologic Nursing, 34(2), 83-91, 82. doi:10.7257/1053-816X.2014.34.2.83
Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.
Cynthia M. Sublett, PhD, RN, CNL, is a Nursing Faculty Member, Xavier University, Cincinnati, OH
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|Title Annotation:||Translating Evidence into Clinical Practice|
|Author:||Sublett, Cynthia M.|
|Date:||Mar 1, 2014|
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