Table 4 KT-MCC Strategy – Intervention Components
KT-MCC Strategy Intervention | Intervention Details | TDF Domains | COM-B Intervention Functions | Rationale/ Evidence |
|---|---|---|---|---|
Workshops to develop local consensus processes | - Participants will be presented with data regarding the functioning of their own MCC in a didactic session - Participants will then be guided to select local consensus processes regarding team purpose and goals - Consensus process will include expectations for: weekly attendance, case submission process, processes of discussion, and MCC documentation, and ‘carrot vs stick’ approach to reinforcement of processes | - Memory, Attention and Decision Processes - Behavioural regulation - Social influences - Environmental context and resources - Goals - Knowledge - Skills | - Environmental restructuring - Education - Persuasion - Restrictions - Coercion | PARTICIPANT FEEDBACK - MCC processes differ by MCC team - Goals for MCC team differ depending on the context of the team and the nature of the disease site EVIDENCE - Workshops are optimized when they involve interactive and didactic sessions [14, 38, 39] - Tailored messaging improves adherence to behavioural interventions [40] |
Team Training | - Team training session led by a team training expert. - Expert will provide MCC participants with actionable recommendations to improve MCC teamworking and soft skills | - Social Influences - Emotion - Skills - Memory, Attention, and Decision Processes | - Training - Environmental restructuring - Enablement - Education - Persuasion | PARTICIPANT FEEDBACK - Gaps in MCC decision making that stem from a lack of ‘soft skills’ EVIDENCE - Training to promote teamworking (i.e., soft skills) as opposed to taskwork (e.g., technical skills) more significantly impacts process outcomes - Business teamworking literature highlights a balance between ‘speaking up’ and ‘listening intensely” [41] - Participants should feel comfortable to ask questions, make mistakes (psychological safety) without negative repercussions[42] - Members should speak freely and challenge status quo [41,42,43,44,45] |
MCC Chair Training | - MCC chairs act as gatekeepers to the success of the KT-MCC- MCC chairs as opinion leaders may influence MCC participant behaviour - Chairs will be invited to participate in a training session with a team training expert who will outline strategies to promote effective discussion, teamwork and efficiency during decision making - The research team will partner with MCC chairs to allow for further KT-MCC Strategy tailoring/ intervention selection | - Memory, Attention and Decision Processes - Behavioural Regulation - Social Influences -Social/Professional Role and Identity | - Modelling - Environmental restructuring - Persuasion - Education - Training | PARTICIPANT FEEDBACK - Lack of MCC leadership found to negatively impact decision making - Gaps in leadership correlated with cyclical case discussions, unequal contributions by MCC participants, and unclear final treatment plans EVIDENCE - Use of opinion leaders in tandem with other interventions can successfully influence behaviour change [13] |
Standardized Intake Form and Synoptic Checklist | - Ensuring preparedness at time of MCC discussion will likely promote discussion clarity and efficiency of decision-making - Submitting physicians will complete a standard intake form prior to the MCC round (e.g., define a clear clinical question, provide a summary of patient history, specify the relevant imaging/pathology required for case discussion) - Chairs will be given a synoptic reporting form to guide case discussion. The form will prompt the chair to ensure relevant information is considered and a final treatment decision is articulated | - Knowledge - Environment - Memory, Attention and Decision Processes - Beliefs about Capabilities - Beliefs about Consequences | - Environmental restructuring - Modelling - Training - Coercion | PARTICIPANT FEEDBACK - Lack of imaging at time of discussion, gaps in patient case history presentation and lack of preparation by presenting physician are barriers - Participants found MCC discussions confusing and organized, and were unsure of how to proceed with treatment - No perceived consequences to lack of participation EVIDENCE - The MDT-QuIC checklist [46] was found to be a useful tool for MCC case preparation, case discussion, and MCC decision records. - The synoptic reporting form will serve as a reminder prompt to chairs and teams [46] |
Audit and Feedback | - Feedback on MCC decision making will be evaluated and fed back to participants - Chairs and teams will select the quality markers to be fed back by research team - Chair will disseminate feedback | - Knowledge | - Modelling | PARTICIPANT FEEDBACK - No feedback on MCC quality (apart from CCO metrics) provided to participants - MCC participants have little knowledge of current MCC quality EVIDENCE - Feedback is most effective when disseminated by a leader, provided on an iterative basis, provided both verbally and in writing, and includes clear targets and recommendations for improvement [47] |