ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 39 of 68
УЖМБС 2021, 6(5): 276–284
Social medicine and organization of health care

Interdisciplinary Approach to Improving the Organization of Surgical Care for Patients with Thyroid Pathology

Klimenko I. A., Tolstanov O. K.

The interdisciplinary approach is recognized as the gold standard for organizing medical care for patients with oncological pathology. It is declared at the normative level in Ukraine, but the forms and methods of work, channels and methods of communication of specialists are not detailed. This requires further research, in particular, when providing surgical care to patients with thyroid pathology. The purpose of the study was to investigate the state of activity organization of multidisciplinary teams in the provision of surgical care to patients with thyroid pathology and to propose approaches for its improvement. Materials and methods: accounting forms No. 003 for 2019 (1208 units), constituent and administrative documents for the institution, department regulations, job descriptions, clinical pathway of patients (15 units in total). The base of research was communal non-profit enterprise "Kiev City Clinical Endocrinological Center". The methods, which were used, are systematic approach, medical and statistical, medical and geographical methods, content analysis, graphic. Results and discussion. Patients of the Department of Endocrine Surgery were from almost all regions of Ukraine. 3.5% of patients were referred by a general practitioner, 55.7% - by an endocrinologist, 40.1% - independently applied. Malignant neoplasm of the thyroid gland was detected in 33.9% of patients, non-toxic multinodular goiter – in 25.2%, benign neoplasm – in 16.3%. In 448 (37.1%) patients, 687 concomitant diseases and complications were identified. Their structure consisted of diseases of the heart and circulatory system – 40.0%, eye diseases – 3.1%, diseases of the nervous system – 2.0%. In order to meet the needs of patients, instrumental and laboratory studies, consultative examinations, consultations and surgical interventions were carried out. The low level of communication between inpatient doctors and outpatient doctors has been shown. This was the reason for the excessive length of stay in bed – 12.6 ± 2.7 days. There is a separate participation of specialist doctors in accompanying patients in the hospital. It was proposed to formalize the official status and develop a typical provision for a multidisciplinary team of specialists; joint discussion, debate, data exchange within the team and with outpatient doctors; afford access to corporate information for the team and coordinate the work of authorized employees. Conclusion. Improving the efficiency of multidisciplinary teams is possible by strengthening collaboration within the team and communication with outpatient doctors

Keywords: multidisciplinary team, patient, healthcare professionals, collaboration, surgical care

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  1. Shidlovskyi OV, Shidlovskyi VO, Dyvak AM. Bezpechnist khirurhichnykh vtruchan na shchytopodibnii zalozi [Safety of thyroid surgery]. Klinichna endokrynolohiia ta endokrynna khirurhiia. 2019; 3 (67): 79-80. [Ukrainian]
  2. Palamarchuk AV, Vlasenko MV. Diahnostyka vuzlovykh utvoren shchytopodibnoi zalozy [Diagnosis of nodules of the thyroid gland]. Praktykuiuchyi likar. 2018; 7(4): 46-52. [Ukrainian]
  3. Iwen A. Schilddrüsensonografie – Schritt für Schritt [Ultrasound Examination of the Thyroid Gland - Step by Step]. Dtsch Med Wochenschr. 2020 Feb; 145(4): 260-267. [German].
  4. National Guideline Centre (UK). Thyroid disease: assessment and management. London: National Institute for Health and Care Excellence (UK); 2019 Nov. [Internet]. Available from:
  5. Sharma R, Verma N, Kaushal V, Sharma DR, Sharma D. Diagnostic accuracy of fine-needle aspiration cytology of thyroid gland lesions: A study of 200 cases in Himalayan belt. J Cancer Res Ther. 2017 Jul-Sep; 13(3): 451-455.
  6. Hernando VU, Eliana MS. Role of Thyroid Hormones in Different Aspects of Cardiovascular System. Endocrinol Metab Synd. 2015; 4: 166.
  7. Baksi S, Pradhan A. Thyroid hormone: sex-dependent role in nervous system regulation and disease. Biol Sex Differ. 2021; 12(1): 25.
  8. Accorroni A, Chiellini G, Origlia N. Effects of Thyroid Hormones and their Metabolites on Learning and Memory in Normal and Pathological Conditions. Curr Drug Metab. 2017; 18(3): 225-236.
  9. Taberna M, Gil Moncayo F, Jané-Salas E, Antonio M, Arribas L, Vilajosana E, et al. The Multidisciplinary Team (MDT) Approach and Quality of Care. Front Oncol. 2020; 10: 85.
  10. European Partnership Action Against Cancer consensus group, Borras JM, Albreht T, Audisio R, Briers E, Casali P, Esperou H, et al. Policy statement on multidisciplinary cancer care. Eur J Cancer. 2014; 50(3): 475-80.
  11. Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, et al. On behalf of the ESMO Guidelines CommitteeThyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019; 30: 1856–1883.
  12. Viola D, Elisei R. Management of Medullary Thyroid Cancer. Endocrinol Metab Clin North Am. 2019 Mar; 48(1): 285-301.
  13. Brito JP, Hay ID. Management of Papillary Thyroid Microcarcinoma. Endocrinol Metab Clin North Am. 2019 Mar; 48(1): 199-213.
  14. Asa SL, Mete O. Endocrine pathology: past, present and future. Pathology. 2018 Jan; 50(1): 111-118.
  15. Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JS. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc. 2018 Jan 19; 11: 49-61.
  16. Janssen A, Robinson T, Brunner M, Harnett P, Museth KE, Shaw T. Multidisciplinary teams and ICT: a qualitative study exploring the use of technology and its impact on multidisciplinary team meetings. BMC Health Serv Res. 2018 Jun 13; 18(1): 444.
  17. Nakaz Ministerstva sotsialnoi polityky Ukrainy vid 26.12.2011 № 568. Pro Poriadok orhanizatsii multydystsyplinarnoho pidkhodu z nadannia sotsialnykh posluh u terytorialnomu tsentri sotsialnoho obsluhovuvannia (nadannia sotsialnykh posluh) [About the Procedure for organizing a multidisciplinary approach to the provision of social services in the territorial center of social services (provision of social services)]. [Ukrainian]. [Internet]. Available from:
  18. Nakaz Ministerstva sotsialnoi polityky Ukrainy vid 31.03.2016. Pro zatverdzhennia Derzhavnoho standartu sotsialnoho suprovodu simei (osib), yaki perebuvaiut u skladnykh zhyttievykh obstavynakh [About the statement of the State standard of social support of families (persons) who are in difficult life circumstances]. [Ukrainian]. [Internet]. Available from:
  19. Nakaz Ministerstva okhorony zdorovia Ukrainy vid 19.10.2018 r. № 1881. Pro zatverdzhennia Obiemu nadannia vtorynnoi (spetsializovanoi) medychnoi dopomohy, shcho povynen zabezpechuvatysia bahatoprofilnymy likarniamy intensyvnoho likuvannia pershoho ta druhoho rivnia, ta Zmin do Poriadku rehionalizatsii perynatalnoi dopomohy [On approval of the Volume of secondary (specialized) medical care to be provided by multidisciplinary hospitals of intensive care of the first and second level, and Amendments to the Procedure for regionalization of perinatal care]. [Ukrainian]. [Internet]. Available from:
  20. Zakon Ukrainy vid 3 hrudnia 2020 roku № 1053-IX. Pro reabilitatsiiu u sferi okhorony zdorovia [About rehabilitation in the field of health care]. [Ukrainian]. [Internet]. Available from:
  21. Natsionalna sluzhba zdorovia Ukrainy. Z lypnia v Ukraini rozpochnut robotu mobilni komandy z nadannia psykhiatrychnoi dopomohy [Mobile psychiatric teams will start working in Ukraine in July]. [Ukrainian]. [Internet]. Available from:
  22. Natsionalna sluzhba zdorovia Ukrainy. Vymohy Prohramy medychnykh harantii – 2021 [Requirements of the Medical Guarantees Program - 2021]. [Ukrainian]. [Internet]. Available from:
  23. Rezoliutsiia seminaru-narady holovnykh pozashtatnykh endokrynolohiv oblastei Ukrainy. Uzahalneni vidomosti roboty endokrynolohichnoi sluzhby 9-ty oblastei Ukrainy [Resolution of the seminar-meeting of the chief freelance endocrinologists of the regions of Ukraine. Generalized information on the work of the endocrinology service of 9 regions of Ukraine]. Probl Endokp Patol. 2018; 2: 108–116. [Ukrainian]
  24. Boisen AS, Balslev NE. [Multidisciplinary teams in cancer care]. Ugeskr Laeger. 2016 Aug 1; 178(31): V10150792. [Danish]
  25. Doubleday A, Sippel RS. Surgical options for thyroid cancer and post-surgical management. Expert Rev Endocrinol Metab. 2018 May; 13(3): 137-148.
  26. Eddy K, Jordan Z, Stephenson M. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature. JBI Database System Rev Implement Rep. 2016; 14(4): 96-137.
  27. Rankin NM, Lai M, Miller D, Beale P, Spigelman A, Prest G, et al. Cancer multidisciplinary team meetings in practice: Results from a multi-institutional quantitative survey and implications for policy change. Asia Pac J Clin Oncol. 2018 Feb; 14(1): 74-83.