Skip to main content

Table 4 KT-MCC Strategy – Intervention Components

From: Use of the theoretical domains framework and behaviour change wheel to develop a novel intervention to improve the quality of multidisciplinary cancer conference decision-making

KT-MCC Strategy InterventionIntervention DetailsTDF DomainsCOM-B Intervention FunctionsRationale/ 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- ModellingPARTICIPANT 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]