Evaluating and improving multidisciplinary team working in breast cancer: the consensus approach to behaviour change

Abstract

Using Michie et al’s (2005) 12 theoretical domains, the aim of this study was to assess and explore feasibility of using the consensus approach to behaviour change (BC) in a breast cancer team. Non-participant observation of 30 care planning meetings was conducted in three phases (baseline, P1, P2). After each phase, we facilitated a discussion with the team including a delivery of data feedback, and formulation of interventions. We then tested the summary proposals. The study took place at a London teaching hospital (2013-2015) with a breast cancer team of 20 members. A validated observational tool with 13 variables, denoting quality of presented information and contribution to discussion by individual disciplines, was used to rate 1335 patient discussions. A one-way ANOVA showed a significant main effect of initial interventions (i.e., change of room layout and appointment of a chair) on contribution to discussion, F(3, 1331)=143.18, p<.001. In P1 and P2, a two-way ANOVA showed significant interaction between the effects of time lapse within meetings and an additional intervention (i.e., 10-minute break) on information presentation, F(1, 984)=5.21, p<.05, and contributions, F(1, 984)=45.55, p<.001. Simple main effects analysis showed significant decline in information presentation and contributions between first and second half of the meeting in P1 (p<.001), and a significant increase in P2 when break was introduced (p<.001). The consensus approach to BC in teams is feasible, and Michie's theoretical domains are useful for designing effective interventions. Team performance grows worse during consecutive efforts, and is positively influenced with a 10-minute break.