Multidisciplinary teams (MDT) in healthcare refer to a group of healthcare professionals from different disciplines and professional groups, who work together to provide holistic, integrated care. The team can include doctors, nurses, allied health professionals and others who have different areas of expertise, and can offer a range of perspectives on the person and family’s care needs.[1]
Multidisciplinary approaches are frequently used for people who have complex health and care needs, in particular life-limiting illness.
Principles of a multidisciplinary approach:
- Effective communication: It is essential for MDT to have communication structures that support all members of the team to share insights and concerns in MDT meetings, as well as having a comprehensive shared health record that all team members have access to. Structured tools for communication are very important.
- Teamwork: MDTs need to have an identified leader who facilitates the work of the team and supports each member of the team to contribute. Team members need to have a shared understanding of the various roles and responsibilities of all team members and demonstrate respect for individual roles. Formal teamwork and communication training is recommended.
- Planning and coordination of care: MDTs require effective planning and coordination to support access to quality palliative care, that is focused on the person and their family, and their individual needs and goals.[2-4]
Multidisciplinary approaches increase the likelihood of people being managed in a holistic, and person and family-centred manner.
As the number of health professionals observing the person increases, the likelihood of needs being overlooked reduces. Multidisciplinary teams (MDT) also enhance and expand the sources of support for the person and family, providing more opportunities to express concern, discuss symptoms and management options, resulting in better experiences of care.[1]
A plan of care is developed through contributions from all relevant disciplines and is based on a comprehensive assessment of the person and their family’s needs. The team works independently, and together with the person and their family, to clarify goals of care and develop a coordinated, needs-based palliative care plan.
Meetings
The MDT meet on a regular basis to discuss each person and their family’s needs, develop or adjust the plan of care to align with their goals and wishes, and reach a consensus on next steps.
In addition to these functions, MDT meetings also have other benefits, including providing team members with opportunities to:
- Gain awareness and appreciate of views of different professions and disciplines
- Learn from and give / receive support among team members in dealing with the nature of palliative care work.[2]
The person and their family are not usually part of regular MDT meetings. However, family meetings are often organised between one or more of the team members and the person and family. These meetings can help to families to better understand approaches to care, and enable them to be involved in decision-making processes.[11]
This CareSearch resource provides some further information on family meetings.
Palliative care is now provided in almost all settings where health care is provided, including neonatal units, paediatric services, general practices, acute hospitals, residential and community aged care services, and generalist community services. AIHW Report [1]
By working collaboratively, the multidisciplinary team (MDT), in any healthcare setting, ensures that all aspects of a physical, psychological, social, cultural and spiritual care needs are addressed, leading to improved quality of life and care outcomes at the end of life.[2]
There are many functions of the MDT in palliative care, including:
- Advocating on behalf people and their families, especially regarding goals of care and advance care planning
- Implementing multiple strategies to address the needs of the person and their family
- Adapting team membership in response to changing needs throughout the person’s experience of life-limiting illness.[3]
Effective MDTs in palliative care
Common barriers to implementing a MDT approach in palliative care include:
- Poor interprofessional collaboration due to ill-defined boundaries and lack of understanding of the roles and scope of other team members. This can negatively impact on consensus in decision-making, especially in at end of life
- Culture of medical dominance, which causes marginalisation of other team members. This imbalance can affect team dynamics and compromise holistic care
- Time constraints and workload impacting on ability to attend MDTs and/or quality of collaboration and communication within the team
- Lack of resources within the organisation to support a MDT approach.[4,5]
In summary, teams that address barriers and function effectively to provide quality multidisciplinary palliative care have the following characteristics:
- Supportive leadership
- Effective teamwork
- Role clarity
- Collaborative communication
- Diverse expertise within the team, allowing for a range of therapeutic options.[6]
Members of the MDT
In the Australian health context, the MDT is most often made up of the following members:
- Doctors: general practitioners, palliative care consultants, and specialists such as surgeons, oncologists, and physicians.
- Nurses: specialists in palliative care or other speciality area often support continuity and coordination of care. Nurse practitioners who specialise in palliative care or other areas can be involved in providing care also.
- Allied health professionals: this includes a wide range of practitioners and professionals who support holistic care and help to optimise quality of life.
- Cultural and spiritual advisors: support the provision of culturally-responsive care, especially for Aboriginal and/or Torres Strait Islander families.[2,7]
Betty has been seen in the Chronic Kidney Diseases (CKD) clinic and the team meeting takes place a few days later. The team plans to discuss Betty as her kidney disease has now progressed to stage 4.
Leanne has been Betty’s Renal Nurse Practitioner since her diagnosis. She is the facilitator of today’s meeting.
The team, through a coordinated approach, has now identified Betty’s symptoms and a management plan has been commenced.
The meeting continues with input from other allied health members of the team. Betty’s functional and nutritional needs are discussed.
Betty’s disease has now progressed to stage 5 or end-stage kidney disease. Betty is dealing with the knowledge that her condition is deteriorating and that she will die from her disease.
She talks about the symptom burden of her disease and highlights the importance of the management plan that has been established by the care team in supporting her and her family through this time.
Betty has been very unwell for a few months and has been unable to attend the CKD clinic at the hospital. She is now bed-bound and extremely weak. Leanne has visited her at home in conjunction with the community palliative care team and Betty’s GP.
The CKD team are meeting following the recent results that Betty’s kidney disease is now end-stage.
Betty is experiencing many of the multisystem effects of uremia, including pruritis, nausea, extreme lethargy and weakness, and anaemia. She is also having trouble swallowing her tablets.
The team suggest a case conference to coordinate a plan of care to manage these multiple issues and to ensure that Betty is able to die at home, as she wants to, supported by her GP and the palliative care team.
One of the benefits of providing multidisciplinary care is a greater adherence to the relevant care standards and guidelines.
Palliative care provision in Australia is guided by:
Also highly relevant to providing care in this context are:
These standards are covered in more depth in Core Module 1: Activity 13.
Alan reflects on his life with Betty and in particular the past few months where he has taken on more of the caring role for Betty.
He speaks about the care team and their support not only for Betty, but for him and their daughter and grandsons.
Tom is a 55-year-old Aboriginal man with advanced lung cancer and multiple metastases. He collapses at home, his family call the ambulance and he is admitted to the ward, extremely breathless. His disease is now end-stage. Tom’s wife Cec and their son Jimmy are with him in the ward.