Assessment of Implementation of Weekly Multidisciplinary Team Decisions for Pediatrics Solid Tumor Patients at SPHMMC, Addis Ababa, Ethiopia

Abstract

Abstract Introduction: Multidisciplinary care (MDC) is recognized as the best practice in the treatment planning and care for patients with cancer since 1995 G.C and Multidisciplinary team (MDT) discussions are the major component of MDC. MDT provides a comprehensive care for pediatric cancer patients that results in reduced treatment delays, improved care processes, improved treatment outcome, higher adherence to guidelines and enhanced support for both patients and their families. Here, we assess the implementation of MDT decision in SPHMMC for pediatrics solid Tumor patients and identify barriers to its effective implementation and provide valuable inputs that help to increase the Effectiveness of the implementation made. Objective: The aim of this study is to assess the Implementation of multidisciplinary team decisions for pediatrics solid Tumor patients in SPHMMC Methods: institution based cross sectional study was conducted among patients discussed on MDT from April 2022 to December 2023. Data was collected using a Data abstraction sheet from MDT format followed by review of medical records. Data was entered into kobo toolbo x application format and entered into a computer and statistical analysis was performed using SPPS version 27.0 for windows. Descriptive analysis was used to describe the percentages and number distributions of the variables in the study. Result: A total of 148 MDT cases were included in the study. The average age of presentation was 3.7 years & most came from oromia region, followed by Addis Ababa. Retinoblastoma was the most commonly discussed cancer, followed by Wilms tumor, rhabdomyosarcoma, ge rm cell tumors and Hodkins lymphoma. 113 (76.3%) of the cases were discussed for the first time & 212 distinct management decisions were reached, of which 156(73.6%) were subsequ ently implemented. Decisions on follow up and palliative care followed by chemotherapy, E UA, surgery and Consults/ communications to other departments were most likely to be successfully enacted. Laboratory and imaging recommendations were less likely to be carried out. Absence of modality for the implementation of MDT decision made in the curren t set up is the major reason for non implemented MDT decisions, followed by illness and fina ncial reasons. Timely implementation of MDT decisions was made for chemotherapy, Pathol ogic testing, EUA and consultation to other departments. Surgical decisions and cystoscopic biopsy took longer duration for implementation. Conclusion and recommendation: MDT discussions are the standard of care for patients with cancer worldwide. Adaptation of MDT discussions as a routine of care for pediatrics solid tu mor patients is a major step up for improving the quality of care given in SPHMMC. All canc an centers in the country should also incorporate this standard of care into their practice. The success of the MDT discussion can further be augmented by increasing the accessibility of im portant modalities of diagnosis & treatment as genetic testing, intraarterial chemotherapy & r adiotherapy respectively. Raising Public awareness on the benefits of community based healt h insurance will also help in relieving the financial burden and increase effectiveness of care given. Key words: Multidisciplinary care, Multidisciplinary team, Implementation, SPHMMC, Pediatric Solid Tumor Patient