Introduction

The ability to communicate effectively is at the core of delivering effective and safe clinical care. This applies to healthcare professionals during patient and carer interactions, as well as to discussions between healthcare professionals. As a consequence, there is a plethora of academic and operational literature defining optimal communication and decision-making frameworks (for example, multidisciplinary team meetings, MDTMs) and the methodology for ‘breaking bad news’. Effective communication with patients, relatives and carers is a fundamental aspect of medicine. The spectrum of patients presenting with gynaecological cancer ranges from young, healthy, asymptomatic patients with screen detected disease and a high chance of cure to elderly, co-morbid, symptomatic patients with a poor performance status who are only suitable for best supportive care. Each will present challenges relevant to their disease state and treatment options.

This chapter focuses on frameworks and guidance for the delivery of gynaecological cancer care in the United Kingdom, and also includes reference to international evidence and guidelines.

The Multidisciplinary Team

The concept of the multidisciplinary team (MDT) meeting may have been pioneered in cancer care; however, it has now been adopted in many aspects of obstetrics and gynaecology. The primary challenge is to define and resource the membership of an MDT. Ideally this should be justified with a firm evidence-base. The mechanics of an MDT meeting are reliant on the venue, technology and communication skills of its membership. These issues will be explored in greater depth.

The MDT: Communication and Clinical Management Decisions

The contemporary structure of gynaecology oncology services in the United Kingdom was developed following the ‘Calman–Hine Report’ (1995) and the subsequent publication ‘Improving Outcomes in Gynaecological Cancers (1999)’. A collection of ‘Improving Outcomes’ documents were produced by what came to be known as the National Cancer Advisory Group to implement the recommendations of the Calman–Hine Report. These documents and recommendations determined that, due to the relatively low incidence of gynaecological cancers compared to more common cancers (breast, colorectal, lung), treatment quality and outcomes would improve with the centralisation of services. There is now compelling evidence to support the principle of centralisation and sub-specialisation of gynaecological oncology services with regard to both patient experience and cancer outcomes. This is particularly evident with the management of ovarian cancer.