A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex

A Delphi consensus report

Stéphane Auvin, John Bissler, Vincent Cottin, Ayataka Fujimoto, Günther F.L. Hofbauer, Anna C. Jansen, Sergiusz Jóźwiak, Larissa Kerecuk, J. Christopher Kingswood, Romina Moavero, Roser Torra, Vicente Villanueva

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Due to the many manifestations of TSC and their potential complications, management requires the expertise of multiple medical disciplines. A multidisciplinary care approach is recommended by consensus guidelines. Use of multidisciplinary teams (MDTs) has been shown to be beneficial in treating other complex diseases, such as cancer. In a lifelong disease such as TSC, an MDT may facilitate the transition from pediatric to adult care. However, little guidance exists in the literature regarding how to organize an MDT in TSC. Methods: To discuss the best approach to assembling an MDT, this project was initiated in October 2017 with a meeting of 12 physicians from various specialties and various countries. Following this first meeting, the experts generated statements on the most important aspects to implement in establishing an MDT for TSC by 3 rounds of selection using a Delphi process via electronic correspondence. Finally, TSC patient advocates reviewed the findings and provided additional insights from a patient perspective. Results: A 3-step roadmap was recommended, starting with identifying a single individual to begin organizing care (Step 1), then establishing a small core team (Step 2), and finally, establishing a larger multi-disciplinary team (Step 3). Because of the multisystemic nature of TSC, the MDT should include specialists such as a neurologist, a neurosurgeon, a nephrologist, a urologist, a pulmonologist, an ophthalmologist, a cardiologist, a dermatologist, a geneticist, and a psychiatrist/psychologist. The MDT should recommend a care plan for each patient based on the individual's needs and in consultation with him/her or his/her family. Some of the most important aspects of an MDT that were agreed upon included identifying a case manager to help coordinate care, providing access to health care professionals of varying specialties, and including a lead physician who takes medical responsibility for patients' overall care. Conclusions: The results of our consensus provide guidance to support the initiation of an MDT in TSC.

Original languageEnglish (US)
Article number91
JournalOrphanet Journal of Rare Diseases
Volume14
Issue number1
DOIs
StatePublished - Apr 30 2019

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Tuberous Sclerosis
Consensus
Transition to Adult Care
Physicians
Inborn Genetic Diseases
Health Services Accessibility
Sirolimus
Psychiatry
Neoplasms
Patient Care
Up-Regulation
Referral and Consultation
Guidelines
Psychology
Mutation

All Science Journal Classification (ASJC) codes

  • Genetics(clinical)
  • Pharmacology (medical)

Cite this

A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex : A Delphi consensus report. / Auvin, Stéphane; Bissler, John; Cottin, Vincent; Fujimoto, Ayataka; Hofbauer, Günther F.L.; Jansen, Anna C.; Jóźwiak, Sergiusz; Kerecuk, Larissa; Kingswood, J. Christopher; Moavero, Romina; Torra, Roser; Villanueva, Vicente.

In: Orphanet Journal of Rare Diseases, Vol. 14, No. 1, 91, 30.04.2019.

Research output: Contribution to journalArticle

Auvin, S, Bissler, J, Cottin, V, Fujimoto, A, Hofbauer, GFL, Jansen, AC, Jóźwiak, S, Kerecuk, L, Kingswood, JC, Moavero, R, Torra, R & Villanueva, V 2019, 'A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex: A Delphi consensus report', Orphanet Journal of Rare Diseases, vol. 14, no. 1, 91. https://doi.org/10.1186/s13023-019-1072-y
Auvin, Stéphane ; Bissler, John ; Cottin, Vincent ; Fujimoto, Ayataka ; Hofbauer, Günther F.L. ; Jansen, Anna C. ; Jóźwiak, Sergiusz ; Kerecuk, Larissa ; Kingswood, J. Christopher ; Moavero, Romina ; Torra, Roser ; Villanueva, Vicente. / A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex : A Delphi consensus report. In: Orphanet Journal of Rare Diseases. 2019 ; Vol. 14, No. 1.
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