Disease-Oriented Teams (DOTs)

Purpose

This statement is intended to introduce disease team leaders to formalize the disease team leader concept and, more generally, the concept of the disease-oriented teams (DOTs) at the University of Arizona Cancer Center (UACC).  DOTs arose at our center primarily in response to a need for more formal and regular communication and coordination of the clinical research effort between faculty members with a given research interest and the other faculty with similar interests and staff members supporting this effort.  For most teams, it is this function that has remained their major objective.  Other teams have evolved to incorporate a greater scope, particularly in also serving as a structure to facilitate scientific interactions between clinical scientists, basic scientists, and research staff.   

Here, we propose to review a proposed mission statement for DOT at the UACC.  We will also define responsibilities and expectations for disease teams.  We will define the relationship of disease teams to other governance and operational components of the center.  Finally, we will define the resources that teams require for their efficient operation.

Proposed Mission Statement

The University of Arizona Cancer Center’s Disease-Oriented Teams (“DOTs”) are made up of faculty and staff with an interest in either a particular class of malignant diseases or conditions, or a particular approach to treatment.  DOTs seek to foster the mission of the UACC by:

  • Focusing the UACC’s research in the area of the team’s interest, encouraging and facilitating collaborative, synergistic interactions between faculty with diverse skill sets, but common intellectual interests.
  • Serving as the intellectual home for clinical and translational research efforts of the UACC in the team’s area of focus, through the cooperative planning, execution and presentation of clinically oriented research
  • Guiding and mentoring the career and intellectual development of team participants, post-doctoral and subspecialty fellows, residents, medical students, graduate students and others with interest in cancer research.
  • Providing expert guidance in the area of the team’s expertise in interactions with constituencies both internal and external to the UACC and the University of Arizona.
  • Conducting the team’s activities in an ethically and fiscally sound manner, mindful of the team’s efforts within the overall context of the UACC mission.
  • Prioritizing the opening of specific protocols and documenting this group discussion in minutes
  • Carrying out monthly meetings
 

Expectations and Responsibilities

In defining the functioning of the DOTs better, the intention is not to overly restrict or regiment the DOT process.  It is to be expected that different DOTs will function in somewhat different ways, reflecting the different diseases, treatment modalities, research interests and skills, and team participant personalities and career objectives.  This diversity contributes to the research process, and is encouraged. 

The Expectation is that the DOTs will discuss new and ongoing protocols monthly and decide which new protocols to bring to the PRMS for evaluation.  If protocols are competing the DOT will make a recommendation to the PRMS which protocols to close.  The DOT will insure that there is a broad set of protocols available for all stages of a specific disease type.  The DOT will involve basic and translational scientists in its membership to enhance the scientific impact of clinical studies.  The DOT leaders will interact with the program leaders on a routine basis and the CROC when issues of the support for specific studies or the ability to carry out specific studies are to be negotiated.  The DOT leader will sign-off on a particular protocol action. 

Participation

As noted above, DOTs should have a broad base of participants, incorporating representatives from clinical, translational and basic sciences.  Participation should be encouraged at all levels, from trainees to experienced investigators.  Depending on an individual’s interests, one might belong, or at least participate in, more than one DOT.  Team participation is not exclusive: persons who are not regular participants in a given team may be invited by the team or the person may request to participate in the team’s discussions and activities. 

For persons who are not formal members of the UACC, their application to UACC membership, at a level commiserate with their education, training and experience, should be encouraged.  An up-to-date record of the regular participants of a given DOT should be maintained.  Optimally, a DOT will have a multi-disciplinary flavor, with representatives from basic and clinical sciences, pathology, radiology, nursing, pharmacy and biostatistics.

Team Leadership

For each DOT, 1-2 key participants are designated by the UACC Director as “team leader/co-leader.”  Team leadership is not a relationship in the sense of the principle investigator in a laboratory.  Instead, this position is intended to be one in which the team’s needs for guidance, coordination and advocacy are provided for.  The team leader should be someone with significant experience and academic commitment to the DOTs focus area.  While this has traditionally been held by clinical researchers, this need not be so.

Team leaders are responsible for:

  • Organizing team meetings and setting agendas for those meetings, in consultation with other team participants.
  • Ensuring that appropriate team records are maintained.  This primarily involves minutes/records of team meetings and retreats, along with a team roster and contact information. 
  • Guiding existing and new participants in the development of collaborative research.
  • Identifying team objectives.
  • Ensuring that all participants are able to participate in team discussions and activities.
  • Representing the teams in relation to the UACC leadership.
  • Signing off on new protocols or changes in protocol priorities. 

Meetings

A key aspect of DOT function is interaction among its core.  Much of this may occur through informal interactions.  However, formal meetings are important to define a given DOT, provide a standard forum for participation both by regular participants and other interested researchers, and to document those activities in a measureable way.  Formal definition of goals also is an important function, to guide the DOTs efforts prospectively.

Formal team meetings may have different goals, and it is left to the discretion of the individual teams to decide how these should be organized.    Two major areas would include meetings focused on either clinical research and the clinical enterprise, or on the overall research enterprise.  The former might include managing ongoing clinical research, required training for staff and investigators, review of new trials for activation or rejection, and review of adverse events.  As the DOTs are also the owners of tumor board organization, these meetings may also serve as forums for the discussion of disease management protocols to be implemented at our center.

While both spheres of activity could be accomplished in a single meeting, several factors argue for different planned meetings.  First, the objectives of the different spheres of activity, while related are distinctly different.  The clinically oriented meetings include a significant component of management of the clinical practice and clinical research enterprise.  In contrast, the more general research work involves much less management focus, being more directly addressing intellectual considerations of the DOT’s ongoing overall research portfolio.  While this might include advice and planning on grant development, management and strategy, such considerations are secondary to the scientific discussions of the meetings.

Second, combining both types of meetings into one meeting will tend to make for excessively long meeting. In such circumstances, some objectives will be abbreviated or not addressed.  Since both areas are critically important, separate meetings addressing the different considerations are called for.

As to meeting frequency, this will vary depending on the needs of the given DOT.  It might be that the different types of meetings (clinical versus research) are held at a different frequency.  For example, a DOT might require twice monthly meetings to manage its clinical practice and research portfolio, but only require monthly meetings for the overall research enterprise.

While much can now be conducted by electronic means, such as email, the intention here is to ensure face-to-face (or at least by teleconference, for DOT participants working outside the area and unable to physically attend meetings) contact at least monthly.  Thus, DOTs should plan in-person meetings at least monthly.  For some teams (for example, those with nascent research programs), it may be possible to complete all required work within a single meeting.  This should be justifiable based on the clinical or research workload of the team, and reflected in team meeting minutes.

At least annually, DOTs should plan a disease oriented “retreat.”  This would be a more in-depth meeting to discuss DOT progress over the prior year, engage in more detailed scientific exchange and planning, and develop a DOT “business plan” for the next year.  Optimally, such a retreat would also produce draft proposals for further development thereafter. 

Retreats should be planned as face-to-face meeting, with teleconferencing being avoided, if possible.  Team retreats should also plan to include those from all sites, including those in Tucson and Phoenix, as well as outlying collaborators.  Agendas for team retreats should allocate adequate time to consider all topics, and include “break-out” time to develop proposals, if warranted.  These objectives may require an overnight stay to avoid agendas too ambitious for the scheduled time.  Like regular meetings, agendas of team retreats should be kept to memorialize the retreat proceedings and for reference moving forward.

Minutes and Records

As noted above, records of DOT meetings are important.  Agendas should be established prior to formal team meetings and review of minutes from at least the prior meeting should be part of the agenda.  Minutes could be as simple as the planned agenda, with records of the team discussions, response and conclusions to the planned topics of the meeting.  The minutes should also include an attendance list.

Annual Objectives

To better coordinate the efforts of the DOT members, as well as to integrate a given DOT better into the UACC enterprise, an important function of the DOT is to establish measurable plans and objectives.  Depending on which aspect of the enterprise is under consideration, this may involve accrual objectives for clinical trials, timelines for grant application preparation, or research resource planning, or any other objective that the team finds worthwhile.

Such goals should be established by the DOT at its annual retreat.  Goals should be reviewed, adjusted, or introduced at regularly planned DOT meetings.  Progress toward team goals should be recorded in meeting minutes.  At the team retreat, objectives from the prior year should be reviewed and adjustments made, if necessary.

Relationship of Teams to Other UACC Components

DOTs will serve a special role at the UACC.  They are intended to be a locus of intellectual exchange and an engine for planning and execution of the UACC’s research mission.  Team leaders are appointed by the Director, interacting regularly with the Associate Directors of Clinical Investigation and Translational Research.  Of necessity, the DOTs also interact closely with the Clinical Protocol and Data Management (CPDM), Protocol Review and Monitoring System (PRMS), Data Safety and Monitoring (DSMB), shared services, and cancer center programs (e.g. Therapeutic Development, etc.).

While there are a variety of committees and services with which DOTs interact in supporting the UACC research mission, it is the DOTs themselves which oversee and guide the research portfolio in a given area.  In addition, the DOTs have the broad range of expertise allowing them to define how clinical treatment of a DOT’s area of interest should be managed.  In that way, the DOT defines the UACC approach to treatment of a given condition.  These local approaches can be put into action through management of regular tumor boards, which fall under the purview of the DOTs.

Resources for Team Operations

DOT operations described above have limited requirements for their operations.  Meeting coordination and recording of minutes will be provided by the CPDM.  Support for retreats will be provided by the Director, through coordination by the Associate Directors of Clinical Investigation and Translational Research.  It is anticipated that funds for the discretionary use of DOTs will become available through discussion with the Clinical Research Council (CROC) and the Associate Director of Clinical Investigations.