Offering a prognosis in lung cancer: when is a team of experts an expert team?

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Abstract
The outlook for patients with lung cancer is poor, so an accurate estimation of prognosis will underpin treatment decisions and allow patients to make personal plans for the future. However, evidence suggests that there is a variation between doctors in their predictions of outcomes and also they tend to be overoptimistic. Two main questions are addressed in this study: whether multidisciplinary team discussion changes prognostic accuracy of individual clinicians; and whether team discussion improves the accuracy of the team’s aggregated prediction. A real-time study of 50 newly diagnosed patients discussed by a regional lung cancer team was undertaken. A case proforma informed the completion of a pre-discussion questionnaire by each team member, seeking prognostic predictions at specific time points. This was repeated after team discussion. Medical notes were reviewed at 6 months to establish actual survival status. Group discussion did not significantly change the accuracy of survival predictions for any one clinician, but the team as a whole performed better after case discussion. Predictions which the clinicians were more confident about were found to be no more accurate than those where they were less confident. There is a wide variation in the range and accuracy of prognostic predictions made by individual clinicians, with no consistent improvement after team discussion. As such predictions are integral to decision making, further research on decision-making processes of clinical teams is required.

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