Multidisciplinary team (MDT) meetings are a mandatory and central part of cancer services globally. Cancer MDT meetings are generally held on a weekly basis and are considered the gold standard for cancer care.1 Although not always obligatory, MDTs are widely implemented internationally but with varying uptake of patient referrals from clinicians.2 The fundamental aim of cancer MDT meetings are to improve individual patient treatment outcomes through discussions held by cancer health care professionals representative of nurses, radiation oncologists, medical oncologists, surgeons, pathologists, and radiologists.3 Timely discussions between MDT clinical experts serves the purpose to deliberate on all clinical treatment options and to develop personalized evidence-informed care recommendations that consider each individual patient's preferences and needs.2

Internationally, cancer MDT meetings are held with all common tumor streams as a health care professional alliance guided by their willingness to agree on evidence-based clinical decisions and to coordinate the delivery of care throughout the cancer trajectory and support patients to take an active role.4 Research studies have shown that given the specialties of cancer MTDs,5, 6, 7 each tumor-specific MDT will have their own barriers and facilitators that affect patient outcomes.2 There is also disparity globally as to whether patients are viewed as part of the MDT or even invited to attend the MDT meeting.

The uro-oncology MDT aims to optimize the clinical management of penile, bladder, prostate, testicular, and kidney cancer.8 However, evidence has underscored that within the specialty of uro-oncology,2 not all patients are reviewed by an MDT, with a distinct lack of patient engagement in the process. Research has shown that when patients are discussed in the MDT meeting, it increases the opportunity for patients to consider taking part in clinical trials; often patients experience changes to management plans from those initially advised to them by their individual treating clinician.9, 10, 11 Consequently, a significant number of patients affected by GU cancers may receive suboptimal clinical management due to not having access to a timely MDT clinical review and not receiving MDT-informed changes to clinical management.2 This is a very important area for future research to understand the complexities (such as public and private hospital settings) and the decision-making process of clinicians who do not refer their patients for an MDT meeting discussion and, importantly, why other patients are referred.

Decision-making is a fundamental process of choosing between alternatives12 to information that is gathered, interpreted, and evaluated in order to select an evidence-based choice of action in health care.13 The cognitive continuum theory14,15 is a decision-making theory that has be widely applied in different health care professional groups,16 including cancer.17 The importance of clinical decision-making processes among the uro-oncology MDT members is central; cancer care and treatments are constantly being challenged due to complex and multimodality therapy,18 and newer, broader emergent considerations, such as geriatric oncology,19 genetic counseling, and addressing unmet survivorship care issues in uro-oncology,20, 21, 22, 23, 24 are currently not being addressed within existing MDT GU cancer services. There is a lack of understanding on how patients are engaged in the MDT discussion to address their individual care needs and preferences for treatment,2 taking into consideration quality of life considerations (urinary, bowel, sexual function, social situation) and the psychosocial impact of cancer. Therefore, the aim of this qualitative study was to understand the clinical decision-making process among the uro-oncology MDT and how patients are engaged in the process.