Impact of a digital solution on case preparation and discussion for breast multidisciplinary tumor board
November 2019 Vol. 10, No. 11 — November 4, 2019
| Donna Fowler, RN, OCN University of Missouri, Columbia, MO |
Lincoln Sheets, MD, PhD University of Missouri, Columbia, MO |
| Matthew S. Prime, MD, PhD Roche Diagnostics, Basel, Switzerland |
Chaohui Guo Roche Diagnostics, Basel, Switzerland |
| Athanasios Siadimas, MSc Roche Diagnostics, Basel, Switzerland |
Richard D. Hammer, MD University of Missouri, Columbia, MO |
Background: Multidisciplinary tumor boards (MTBs) provide an interdisciplinary approach for decision-making in cancer care. Efficient preparation and conduction of MTBs are critical for time to treatment and patient outcome. It is largely unknown how digital tumor board solutions impact case preparation and discussion for MTBs.
Objective: To evaluate the impact of a digital solution for tumor boards.
Methods: A prospective study was undertaken to evaluate the impact of NAVIFY® Tumor Board (NTB) on the accredited breast MTB at the University of Missouri Health Care. NTB is a cloud-based workflow product that integrates with the hospital EMR and displays relevant aggregated data as a holistic patient dashboard. Student’s t test was performed in cases where data met the assumption of normality, and Mann-Whitney test otherwise.
Results: Interim results are presented for 2018 data.
Case Preparation: Time preparation for 20 breast MTBs (120 cases) was evaluated: 10 MTBs (60 cases) in pre-NTB vs 10 MTBs (60 cases) in post-NTB. Total preparation time across cases during pre-NTB was distributed as: 48% contributed by nurse navigator (NN), 42% by pathology resident, 5% by genomics, 6% by radiologist. Because percentage time contribution from geneticists and radiologists was negligible, comparative analysis for these two roles was not possible. Impacts on the meeting preparation time vary across roles in pre- vs post-NTB implementation. NN preparation time decreased from 36.0 minutes (SD = 22.6) to 12.8 minutes (SD = 6.5), representing a 64% reduction (t test; P = .008). Pathology resident preparation showed no significant change, 33.1 minutes (SD = 12.1) to 31.1 minutes (SD = 16.5) (t test; P = .3).
Case Discussion: Patient case discussion time was based on data from 24 breast MTBs (144 cases): 14 MTBs (86 cases) in pre-NTB vs 10 MTBs (58 cases) in post-NTB. Case discussion time significantly reduced from 6.6 minutes (SD = 1.5) to 5.3 minutes (SD = 0.9) in pre- vs post-NTB implementation (t test; P = .015).
Conclusion: NNs and pathology residents contributed the most time for case preparation at this institution. The introduction of NTB reduced staff workload and increased the efficiency of case preparation for breast cancer MTBs. The impact was greatest for NNs, possibly because this was a single user compared with pathology residents who rotated every 8 weeks. In addition, the introduction of NTB standardized and reduced case discussion time at MTBs. Future investigation is needed to examine the impact of NTB based on a larger number of patient cases and from multi-sites, as well as the impacts on different cancer MTBs.
