The Design, Implementation and Evaluation of the KT-MCC Strategy: A Knowledge Translation Strategy Aimed At Improving The Quality of Decision Making For Ontario Multidisciplinary Cancer Conferences

Abstract

Multidisciplinary cancer conferences (MCCs) are prospective meetings to discuss diagnoses and treatment plans for patients with cancer. MCCs are typically attended by surgeons, medical and radiation oncologists, pathologists and radiologists. To date, the quality of MCCs, specifically MCC decision making, has not been formally evaluated in a Canadian context. We utilized progressive knowledge translation methodology, specifically the use of theory, models and an integrated knowledge translation approach, to design, implement and evaluate an intervention, titled the KT-MCC Strategy (KT-MCC). The purpose of the KT-MCC is to improve the quality of MCC decision making. This thesis is comprised of four parts. In Part 1, we completed a generalizability study to evaluate the reliability of an MCC assessment tool (MTB-MODe) in an Ontario context. In Part 2, we conducted key informant interviews using the Theoretical Domains Framework (TDF) to identify barriers and facilitators to optimal MCC decision making. In Part 3, we mapped identified TDF barriers and facilitators to the COM-B Behavioural Change Wheel to develop the KT-MCC, an intervention aimed at improving the quality of MCC decision making. In this study, we examined the validity of the key informant findings using focus groups and surveys completed by individual MCC participants. In Part 4, we conducted a before-and-after pilot study to evaluate the feasibility and impact of the KT-MCC on MCC decision making in preparation for a possible randomized controlled trial testing the efficacy of the KT-MCC. There are few examples in the KT literature that provide a complete and detailed description of the design, implementation and evaluation of a complex KT strategy using progressive KT methods such as TDF interviews to identify barriers and facilitators to practice change; the COM-B model to identify potential interventions; and use of integrated KT with front-line workers. We describe in detail our methods to design, implement and evaluate the KT-MCC. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario.