Validation of the measure of case-discussion complexity (MeDic) and the metric for the observation of decision-making (MODe) for streamlining workflow and evaluating decision-making in US tumor boards

Background Clinical guidelines for cancer care recognize multidisciplinary tumor boards (MTBs) as a gold standard for providing quality of care for cancer patients. However, the requirements and workflow for MTBs varies across countries, influencing their roles in decision making, care efficiency, and medical education. This study compares validity and performance of MDT evaluation tools, Measure of case-Discussion Complexity (MeDiC) and Metric for the Observation of Decision-Making (MODe) in the UK versus US. Methods MeDiC, developed to assess case complexity, and MODe, designed to evaluate decision-making quality, were applied to 555 cases and 104 MTB meetings from urological and gynecological tumor boards at an academic cancer center between December 2021 and June 2024. MeDiC was used to assess clinical complexity through pathology, patient, and treatment factors, while MODe evaluated decision-making quality based on patient information and team contributions. All assessors underwent formal training. Data analysis included reliability testing using intraclass correlation coefficients (ICCs), Kappa, Cronbach's alpha, and bootstrapping was used to estimate confidence intervals for correlation estimates. Results MeDiC demonstrated good reliability (ICC = 0.849) in the US MDT and identified key factors contributing to complexity, such as malignancy and significant comorbidities. The tool also revealed that case discussion duration was not significantly associated with complexity levels. MODe similarly showed moderate reliability (ICC = 0.628), with high correlations between decision-making quality and contributions from core specialties such as medical oncologists. Conclusions The validity of MeDiC and MODe in the US was similar to the tools' performance in the UK settings. However, case complexity metrics demonstrated significant selection of more complex cases for US MDT presentation compared to UK MDTs.