National Peer Review Measures for the Thoracic Cancers Multidisciplinary Team

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1 National Peer Review Measures for the Thoracic Cancers Multidisciplinary Team Project Name: Peer Review Date: 26/05/2014 Release: FINAL Author: Owner: Client: Document Number: Timothy Jackson Cancer Information & Peer Review Manager SCH MDT- thoracic Next Review Date: May 2016

2 MDT-thoracic-1. Description of the service There should be a description of the Thoracic MDT [or private provider] that includes where it is located, what population it serves, what cancer(s) it deals with. MDT-thoracic-2. Number of new cases by ICD10 code, subtype, staging in the current year and number of newly diagnosed patients per year, previous year Description of service in The team should record new cases and diagnosed patients discussed at the MDT each year [or sent to a compliant MDT for discussion]. MDT-thoracic-3. Single named lead clinician There should be a single named lead clinician with agreed list of responsibilities for the Thoracic MDT who should then be a core team member [or for the service, who should then attend an MDT that discusses referred patients]. MDT-thoracic-4. Core team members and cover The core team specific to the Thoracic MDT should include: a designated respiratory physician; a designated thoracic surgeon; a medical oncologist; a radiation oncologist; an imaging consultant; an interventional radiologist; a histo-pathologist with External Quality Assurance (EQA) for thoracic cancers; a designated cyto-pathologist; an advanced clinical nurse specialist for thoracic cancers who can provide level 2 psychological care and receives monthly clinical supervision and who is also responsible for user issues and information for patient and carers; a specialist palliative care doctor or advanced clinical nurse specialist; an MDT coordinator/secretary; *a member of the core team responsible for the recruitment into clinical trials. Clinician named and agreed list of responsibilities in the Roles, subspecialisation and agreed cover listed in the Core consultant members should spend 50% of their time on the care of thoracic cancers. Named Extended Core Team Members: an oncology clinical pharmacist; psychologist/psychiatrist Page 2 of 7

3 Measures chaplain/pastoral care worker/religious leader bereavement care worker There should be cover arrangements in place for the key roles [or the team that patients are referred to should be compliant]. MDT-thoracic-5. Weekly MDT meetings The MDT should have treatment planning meetings scheduled every week unless the meeting falls on a public holiday [or the team that patients are referred to should be compliant]. MDT-thoracic-6. Attendance at meetings All core members of the MDT should attend at least two thirds of the number of meetings [or the team that patients are referred to should be compliant. Clinicians (or a delegate) referring to a compliant MDT should attend 100% of meetings where their patients are discussed]. MDT-thoracic-7. Operational Policy Annual Report lists the dates of all scheduled meetings and the names and roles of core members. Includes a list with dates of meetings that did not occur and rationale. Annual Report includes meeting attendance data. The records should include the dates of all scheduled meetings and the names and roles of core members. The MDT [or private provider] should have an Operational Policy available that describes who treats and cares for those who present with a primary thoracic malignancy such as nonsmall cell lung cancer, small cell lung cancer and mesothelioma. It should describe how the team functions and how multidisciplinary care & treatment is delivered across the patient pathway, including risk stratified follow up and survivorship programs. It should outline the various policies/processes that govern how the team provides safe/high quality care. It should contain agreement to and demonstration of the clinical guidelines including interventional radiology, chemotherapy regimens, treatment protocols and pathways, risk stratified follow up, survivorship programs and access to palliative care. There should be a written procedure governing how to deal with referrals which need a treatment planning decision before the next meeting [the team that patients are referred to should be compliant and the referring service should also have an operational policy that covers those parts of the pathway covered by the service and contains policies and pathways for referring to a compliant MDT]. Page 3 of 7

4 MDT-thoracic-8. Patients referred to the MDT should only be seen in specialist clinics There should be pre-assessment and follow up clinics. The preassessment clinic should occur prior to the delivery of the first definitive treatment. The pre-assessment clinic should include at least: one core member of the surgical team one core member of the oncology team a core member advanced clinical nurse specialist a member of the extended members of the MDT who is responsible for psychological support for patients MDT-thoracic-9. Designated privileged clinicians Patients referred to the MDT should only be treated by clinicians (surgeons, radiation oncologists, medical oncologists) who have been privileged to diagnose and treat thoracic cancers and who spend 50% of their time on the care of these cancers. MDT-thoracic-10. A designated hospital for providing surgical thoracic cancer services List of clinics with named clinicians in the Operational Policy. List of privileged clinicians in the Operational Policy and their individual activity. Designated areas identified in The designated hospital must have: an intensive care unit on site specialist ward MDT-thoracic-11. Number of urgent referrals for suspected cancer made/received The MDT [or private provider] should be aware of the number of urgent referrals for suspected cancers and the different sources/destinations of referrals. MDT-thoracic-12. Cases managed at this MDT with a definitive diagnosis (primary or secondary) of thoracic cancer by ICD10 code Number of urgent referrals for suspected cancer by source/destination of referral in the Number of cases by ICD10 code in the The MDT [or private provider] should monitor their workload. MDT-thoracic-13. Agreed Tumor Board clinical guidelines The MDT [or private provider] should agree the clinical guidelines specified by the tumor board. MDT-thoracic-14. Number of interventional radiology cases by ICD10 code and individual interventional radiologist Guidelines listed or referenced with signed agreements in the Operational Policy. Number of cases by ICD10 code and procedure type in the Page 4 of 7

5 MDT-thoracic-15. Number of surgical cases by ICD10 code, resection rates and outcomes by individual surgeon The MDT [or private provider] should monitor their practice. MDT-thoracic-16. Number of patients treated with systemic anti-cancer treatment and regimen The MDT [or private provider] should monitor their practice. MDT-thoracic-17. Agreed radiotherapy methods, including brachytherapy, number of patients receiving radiotherapy and fractions delivered The MDT [or private provider] should monitor their practice. MDT-thoracic-18. Defined patient pathways including diagnosis, interventional radiology, surgical resection, systemic therapy, radiotherapy, risk stratified follow up, survivorship, palliative and end of life care. Number of cases by ICD10 code, type of surgery and individual surgeon in the Annual Report; include a summary of those patients who presented to the MDT too late for surgical resection. Number of cases, by regimen, Report. Number of cases treated with radiotherapy & fractions delivered documented in the Patient pathways described in the The MDT [or private provider] should agree the specified patient pathways with the tumor board. MDT-thoracic-19. Individual patient treatment plans The MDT [or private provider] should have a policy to agree and record individual patient's treatment plans for every patient reviewed by the MDT. The record should include: Documented in the the identity of patients discussed plan for interventional radiology, if required the multidisciplinary treatment planning decision (i.e. to which modality(s) of treatment - surgery, radiotherapy, systemic therapy, hormone therapy or supportive care or combinations of the same, that are to be referred for consideration) Treatment intent: curative or palliative Patients treated with off protocol therapies must be documented with rationale Off protocol therapies Report and discussed with tumor board for consideration for mainstream use. Page 5 of 7

6 MDT-thoracic-20. Attendance at the Tumor Board The lead clinician of the MDT [or private provider] or representative should attend at least two thirds of the tumor board meetings. MDT-thoracic-21. Provision of written material for patients and carers The MDT [or private provider] should provide written material for patients and carers which includes: information specific to that MDT about local provision of the services offering treatment(s) for that cancer site; information about patient involvement groups and patient self-help groups; information about the services offering psychological, social and spiritual/cultural support, if available; information specific to the MDT's cancer site or group of cancers about the disease and its treatment options (including names and functions/roles of the team treating them); information and named key professionals regarding services available to support the effects of living with cancer and dealing with its emotional effects. MDT-thoracic-22. Patient survey The MDT [or private provider] should have undertaken an exercise during the previous two years prior to review or completed self-assessment to obtain feedback on patients' experience of the services offered. MDT-thoracic-23. Surgical or interventional radiology cases readmitted as an emergency within 30 days and rationale for readmission Attendance records included in the Information should be listed and described in the Results in the Annual Report, or in work plan to do so. Results discussed by the MDT and actions for improvement in the work plan. Numbers of cases and rate Report. The MDT [or private provider] should be aware of treatment outcomes. MDT-thoracic-24. Mortality within 30 days following interventional radiology, surgery or systemic anti-cancer therapy (chemotherapy) Numbers of cases and rate Report. The MDT [or private provider] should be aware of treatment outcomes. Page 6 of 7

7 MDT-thoracic-25. Clinical Lines of Enquiry The MDT [or private provider] should record and compare with international comparators and where practice differs, develop remedial action plan. An annual review and discussion published in the Remedial action detailed in the work plan. The percentage of expected cases on whom data is recorded The percentage of patients receiving an interventional radiology procedure The percentage of histological presentation The percentage of patients having active treatment The percentage of surgical resection rates (all cases excluding mesothelioma) The percentage of small cell lung cancer patients receiving chemotherapy MDT-thoracic-26. Discussion of audit The MDT [or private provider] should annually review their data, discuss the progress of their audit or discuss the completed results. MDT-thoracic-27. Discussion of Clinical Trials The MDT [or private provider] should produce a report annually on clinical trials, for discussion with the tumor board. MDT-thoracic-28. Agreed Advanced Clinical Nurse Specialist responsibilities which include: Presence at diagnosis or delivery of significant news Development of Patient Information and Support Undertaking Holistic Needs Assessment at key milestones of the pathway (e.g. diagnosis, treatment decision making, end of treatment) Development of Survivorship Programs Nurse lead clinics Provide Level 2 Psychological Care Results or discussion in the Annual Report, or in work plan to do so. An annual review and discussion published in the Remedial action detailed in the work plan where uptake is poor in relation to other comparative centers. Defined in the Operational Policy and Advanced Clinical Nurse Specialists job plan. Page 7 of 7

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