Physician and Nurse Experience and Work Satisfaction at a Gastrointestinal-Oncological Multidisciplinary Fast-Track Diagnostic and Treatment Planning Outpatient Clinic

Abstract

Background: The Gastro-Intestinal Oncological Centre Amsterdam (GIOCA) located at the Academic Medical Centre (AMC) in Amsterdam, is a multidisciplinary fast-track diagnostic and treatment planning outpatient clinic. Multidisciplinary teams (MDTs) have been formed to cope with the complexity of gastro-intestinal (GI) malignancies. The GIOCA team consists of surgeons, gastroenterologists, medical oncologists, radiotherapists, radiologists, nuclear radiologists, pathologists and specialized nurses. Many studies have focused on patient perceptive in a fast track multidisciplinary clinic, not many studies focus on the perspective of physicians or nurses in relation to working within a MDT. Our aim was to evaluate this perspective. Methods: A qualitative observational study was performed in 2013. Eight physicians from the GIOCAwere individually interviewed. With three nurses a group interview was held. From the interviews determinants were deduced to compose a questionnaire. The questionnaire consisted of twelve questions. Answers were provided on a 5-point Likert scale. The questionnaire was sent to every physician (medical specialist, fellow and resident) and specialized nurse working at GIOCA. Data were analysed using non-parametric tests and expressed as median and range. Results: The questionnaire was answered by 73 out of 77 respondents (95% response rate), consisting of 67 physicians and 6 nurses. The workload was experienced as average (3; 1-4) by physicians and high (4; 4-5) by nurses (p < 0,001). The highest emotional strain was reported by nurses (3; 2-4) and residents (3; 1-4), both were significantly higher (p = 0,031, and p = 0,036 respectively) than the emotional strain reported by specialists (2; 1-4). The experienced workload for all physicians and nurses was equal for the different tumor types (3; 1-4). The importance of a multidisciplinary fast-track diagnostic outpatient clinic was rated high to very high with a median rating of 4 by pathologists (4; 3-4, radiologists (4; 4-5) and radiotherapists (4; 3-5) and a median rating of 5 by surgeons (4; 3-5), gastroenterologists (4; 3-5), medical oncologists (4; 4-5) and nurses (4; 4-5). This difference was not significant (p = 0,14). The quality of the MDT-meeting was rated high by physicians (4; 2-5) and nurses (4; 3-4). Radiologists rated the quality of the MDT-meeting with a median of 5 (5; 4-5). This difference was not significant (p = 0,10). Overall satisfaction of working at GIOCA was high with an overall median of 4 (4; 3-5), except for pathologists, whose overall satisfaction was rated 3 (3; 3-5). This difference was not significant (p = 0,45). Conclusion: The overall quality and the overall work satisfaction of working in a complex multidisciplinary GI-oncological outpatient clinic is high. Nurses experience a significantly higher workload than physicians. Nurses and residents report a significantly higher emotional strain than medical specialists. Both nurses and physicians recognize the importance of a multidisciplinary fast-track diagnostic and treatment planning outpatient clinic.