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中国肺癌多学科协作诊疗模式运行现状及分析

Current Status and Analysis of Multidisciplinary Team Model for Lung Cancer in China

  • 摘要:
    目的 调查我国肺癌多学科协作诊疗模式(MDT)的运行现状,为MDT模式的推进及优化提供依据。
    方法 2023年4月—2023年11月,以肺癌临床诊疗医生为研究对象,采用线上及线下结合的问卷调研方式,对MDT模式的认知水平、所在医疗机构的实施现状、运行机制及临床应用中的主要挑战与优化路径进行调研,调研数据采用描述性分析。
    结果 共收集问卷1 137份,受访者覆盖全国31省市的816家综合及肿瘤专科医院。88.1%的医生认为现行MDT模式可行有效,在患者生存受益、提升诊疗效率、推动诊治水平及规范化、增加临床研究入组方面具有重要价值;83.5%的医生表示其所在医院建立了MDT团队,团队包含MDT主席/首席及协调员/秘书,保证MDT的运营及随访;MDT开展频率较低且时间较长,通常为一个月1~2次且一例病例讨论时长超过30分钟,50.1%的医生表示MDT病例占年诊疗病例小于25%。团队时间难协调、缺乏行政支持和激励手段是影响MDT运行的难点,而明确患者条件是最多被认为可提升MDT效率的优化方向。
    结论 经过了10余年的探索实践,我国肺癌的MDT模式得到了推广应用。优化MDT病例的筛选和诊疗流程,提供行政支持和激励措施是提升MDT运行效率、惠及更多肿瘤患者的关键。

     

    Abstract:
    Objective To investigate the current status of multidisciplinary team (MDT) approaches in lung cancer management in China to provide a basis for the further promotion and enhancement of the MDT model.
    Methods From April 2023 to November 2023, physicians engaged in the clinical diagnosis and treatment of lung cancer were selected as the research objects. Questionnaires were distributed online and offline to investigate the cognition of MDT mode, MDT operating mode of their hospital, challenges faced, and direction of improvement. Descriptive analysis was conducted on the survey results.
    Results A total of 1137 questionnaires were collected, covering 816 general and cancer hospitals in 31 provinces and cities across the country. A total of 88.1% of doctors believe that the current MDT model is feasible, effective, and is of great value in benefiting patients’ survival, improving diagnosis and treatment efficiency, promoting diagnosis and treatment level and standardization, and increasing clinical research enrollment. Meanwhile, 83.5% of doctors state that their hospital has established an MDT team, including a chair and a coordinator, to ensure the smooth operation of the MDT and follow-up. The frequency of MDT is low and the time is long, usually 1–2 times a month and more than 30 minutes discussion time for each case. In addition, 50.1% of doctors indicate MDT cases account for less than 25% of annual diagnosis and treatment cases. Time coordination challenges and lack of administrative support and incentives are the difficulties affecting the operation of MDT. Having well-defined patient criteria is frequently cited as a key area for optimization that could remarkably enhance MDT efficiency.
    Conclusion After more than a decade of exploration and practice, the MDT model for lung cancer in China has been widely promoted and applied. Optimizing the selection, diagnosis, and treatment of MDT cases and providing administrative support and incentives are the key to enhancing the efficiency of MDT and expanding their benefits to a great number of patients with cancer.

     

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