An approach to multidisciplinary team (MDT) meeting practice

What is a diffuse lung disease MDT meeting?A forum that enables the integration of all available clinical, radiological and pathological data for an individual patient for the purposes of diagnostic synthesis.
What is the main goal of the MDT meeting in the setting of diffuse lung disease?The primary goal of MDT meetings is to discuss and establish diagnosis. In some cases, management strategy inevitably flows from diagnosis, e.g. the prescription of antifibrotic therapy in patients with IPF.
Who are the requisite participants in the MDT meeting?If the primary goal of MDT meetings in the setting of DPLD is diagnostic synthesis, then the requisite participants are the respiratory physician, radiologist and pathologist.
Who leads the MDT meeting?In most cases, the participant who has performed a face-to-face evaluation of the patient should lead the MDT discussion.
What is the minimum dataset needed for diagnostic synthesis in an individual diffuse lung disease patient?The lack of standardised diagnostic criteria in diffuse lung disease means that defining the minimum required dataset is not possible at present.
Should the MDT meeting outcome be documented?Ideally, the outcome of the MDT discussion should be recorded in the patient's clinical records. A dedicated proforma for recording MDT discussion outcome may inform service improvements as well as facilitate research.
Do all cases of DPLD require MDT meeting evaluation?Experienced MDTs may wish only to discuss cases where there is inter-specialty diagnostic disagreement or where the disease is not easily classified. Less experienced MDTs may initially wish to discuss all cases of diffuse lung disease.
How often should an MDT meeting take place?The DPLD MDT meeting frequency will depend on the experience of the group and the number of patients being evaluated. New groups may wish to discuss all cases but may have insufficient patient numbers to fill a weekly MDT meeting. Experienced groups may have large numbers of patient referrals and may need to triage patient that require discussion at a weekly meeting.
How can DPLD MDT meeting performance be appropriately evaluated?MDT meeting performance can be evaluated in terms of diagnostic accuracy, participant experience and cost effectiveness. Diagnostic agreement and diagnostic confidence may be used as surrogates for diagnostic accuracy. Specifically in IPF, outcome distinctions between IPF and other diffuse lung diseases may be used to validate diagnostic accuracy. Participant experience may be assessed using questionnaires and cost-effectiveness studies may be used to assess feasibility.

IPF: idiopathic pulmonary fibrosis; DPLD: diffuse parenchymal lung disease.