Patients’ Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings

BackgroundThe contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions.DesignObservations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed.ResultsIn the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available.LimitationsThe design of the study made it difficult to draw definite cause-and-effect conclusions.ConclusionThe Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians’ everyday professional practice. The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

## 背景
患者的非医疗特征对个体医师决策的影响已受到广泛关注，但在集体决策场景下相关研究信息仍较为匮乏。目前癌症中心的医疗决策多采用多学科团队（MultiDisciplinary Team, MDT）会议的集体决策模式。本研究旨在探究患者的非医疗特征在MDT会议中的呈现方式，以及此类信息如何影响团队最终的医疗决策。
## 研究设计
2014年3月至5月期间，在法国某癌症中心开展观察性研究，针对涉及不确定性的非标准病例开展MDT会议讨论。采用非参与式观察法收集医师的口头陈述与预设的情境参数。随后将以开放式笔记形式采集的非数值数据进行编码，以开展定量分析，并完成单变量与多变量统计分析。
## 结果
纳入并讨论的最终患者病例样本量为290例（N = 290），其中32.8%（n = 95）的病例提及了患者的非医疗特征。此类特征可分为三类：人口统计学特征占22.8%（n = 66）、心理学特征占11.7%（n = 34）、人际关系特征占6.2%（n = 18）。提及频率最高的特征为患者年龄与“亲和力”。在17.9%的讨论病例中，最终决策被暂缓；该结局与患者的非医疗特征以及可选治疗方案的结局不确定性呈正相关。
## 局限性
本研究的设计难以得出明确的因果关系结论。
## 结论
社会表征（Social Representations）理论视角表明，患者的非医疗特征属于一种隐性专业知识，可能常被医师在日常临床实践中调用。本次研究观察到的患者属性与会议中医疗决策之间的关联提示，在理解此类复杂困境下的医疗决策制定过程时，应将此类属性纳入考量范畴。