Investigating the effectiveness of breast cancer teams in Ireland: the role of interprofessional team processes

While there is sufficient research evidence to suggest that a multidisciplinary team approach improves the outcomes of patients, specifically those with breast cancer, limited attention has examined the extent to which certain inter-professional team working processes coordinate the multiple disciplines involved in a way that facilitates improved team effectiveness, specifically in breast cancer care in Ireland. Therefore, this study was carried out in order to examine the multidisciplinary team working process and its impact on the effectiveness of multidisciplinarity in the regional specialised breast cancer centres in Ireland. Three breast cancer teams were investigated using a mixed methods approach. It involved (1) a bespoke questionnaire comprising multiple previously published/validated scales, which was completed by the team members, (2) follow-up interviews with core team members and (3) a questionnaire designed, standardised and validated by Picker Institute1, which was administered to a minimum of one hundred patients per team who were attending the teams’ review clinics. In this study, team outcomes were predicted by a number of team process variables. Specifically, the ratings of various aspects of team effectiveness were predicted by innovation & flexibility and the professional development of team members. Other team outcomes, such as work satisfaction, general mental health and the overall team effectiveness score, were predicted by the following: participation in decision-making, communication of the team’s long-term plans and goals, intra-team communication, innovation & flexibility, professional development and leadership & supervision. However, follow-up interviews highlighted challenges involved in implementing these team working processes in practice. The lack of understanding and appreciation of one another’s roles and limited communication were the most commonly cited. In addition, findings from the patient questionnaire drew attention to the lack of sufficient clinical nurse specialist staffing in the multidisciplinary team. This had an impact on maintaining communication between the team and the patient, particularly in the provision of emotional and educational support during the patient’s cancer care. Together, the findings of this study point to a number of important implications for theory, policy and practice. The most salient of these are as follows: the need for increased role clarity and recognition and improved communication both within and between the teams and between the teams and patients; sufficient staffing in oncology liaison nursing to support communication between the team and the patient; as well as team building exercises. If implemented, these practices would afford the opportunity for improvement in these breast cancer teams before practices that contribute to less than optimal team performance become embedded.