Multidisciplinarity in healthcare, especially for cancer treatment, is considered a suitable strategy for tackling growing complexity through a collaborative approach. The multidisciplinary tumour board approach integrates various medical professionals specializing in a particular cancer, aligning on evidence-based decisions and coordinated care, thereby encouraging patient involvement.¹ A Cochrane review defines it pragmatically as ‘any practice-based intervention with an explicit objective of improving collaboration between two or more health or social care professionals’.² The popularity of the multidisciplinary tumour board approach has markedly increased in recent years, particularly within the oncological sector. A simple PubMed search for ‘multidisciplinary’ returns over 195 000 entries, with a notable increase since 1955. For instance, the Journal of Multidisciplinary Healthcare has published 1803 studies since its inception in 2008. Such approaches are increasingly common in medical fields like oncology, cardiology, neurology, palliative care and geriatrics, which often involve complex health issues necessitating collaboration across specialties. This is also the case for liver disease; a search for ‘multidisciplinary AND liver disease’ on PubMed shows 5600 articles since 1972, reflecting a growing interest.

Hepatocellular carcinoma (HCC), a complex disease with multiple therapeutic options and substantial variability across different centres and regions, exemplifies the need for multidisciplinary decision-making in uncertain conditions.^{3, 4} In its recent practice guidance on prevention, diagnosis and treatment of hepatocellular carcinoma, the American Association for the Study of Liver Disease (AASLD) strongly recommends (level 3 of evidence) the use of multidisciplinary approaches, primarily via tumour boards, with the aim to facilitate a comprehensive discussion on patient management. These boards typically involve hepatologists, radiologists, pathologists and oncologists, ensuring a multidimensional assessment of treatment options.⁵

The supporting evidence for this recommendation, however, is limited and methodologically weak. It is based on a systematic review⁶ incorporating 12 studies, none of which were randomized clinical trials. Additionally, the studies predominantly utilized a pre-post design (seven studies) or were retrospective analyses (five studies) with inadequate control for confounding variables. While the data suggest a positive association between multidisciplinary care and enhanced survival rates (hazard ratio (HR) = 0.63, 95% CI: 0.45–0.88), the findings are flawed by considerable unexplained heterogeneity (I² = 95%). Finally, patients in multidisciplinary care were more likely to present with early-stage HCC, as evidenced by a risk ratio (RR) of 1.60 (95% CI: 1.12–2.29). An earlier stage is itself a positive prognostic factor and should actually be considered a confounding variable capable of influencing the study results. The overall impact of these methodological issues casts doubts on the reliability of the conclusion that multidisciplinary care unequivocally benefits HCC patients. Thus, in our opinion, this instance illustrates how optimism may subtly shape the interpretation of findings, transforming wishful thinking into perceived evidence.

However, our main concern lies not with the interpretation of the results but rather with the ambiguous and poorly defined nature of the intervention multidisciplinary care (MDC) and its comparator. The concept of multidisciplinary care varies significantly, from multidisciplinary conferences for imaging and decision-making to evaluations in a joint clinic setting,^{7, 8} or interactions with at least three distinct disciplines in the early diagnostic and treatment stages.⁹ Complicating matters further, the lack of details on the treatment methods in the historical control group hamper any meaningful comparison. Analysing the differences between variously coordinated multidisciplinary care protocols and a wide array of uncoordinated care approaches poses a significant challenge. In this context, even an intervention with minimal structure may appear beneficial when set against a completely unstructured approach.

The push for multidisciplinary protocols in medicine emerges from the increasing fragmentation into numerous specialties and subspecialties. This specialization, while necessary for complex multisystemic diseases, often leads to a narrowed focus and rigid boundaries, giving rise even to ‘sub-subspecialties’.¹⁰ This trend limits a comprehensive view of patient problems, as issues are interpreted strictly within specialty confines, even when they extend beyond.¹¹ The shift towards narrower specializations and a growing number of care providers detracts from a holistic view of patient care,^{5, 12, 13} while strengthening the false belief that ‘more is better’ in complex medical scenarios. However, also multidisciplinary care approaches carry substantial drawbacks and risks, for both the patients and the healthcare systems (Table 1).¹⁴

Promoting effective decision-making is difficult, as group dynamics can lead to suboptimal outcomes.¹⁵ It is important to develop strategies that foster independent, critical thinking within groups and prevent information cascades, where individuals mimic the actions or beliefs of others, potentially triggering widespread, yet possibly unfounded, consensus. Addressing this requires tackling the nuances of information cascades.¹⁵ Additionally, group polarization often leads to more radical decisions than individual members would make alone.¹⁵ Recognizing and mitigating these group dynamic effects is essential. Research should investigate these decision-making complexities in multidisciplinary boards and seek ways to minimize bias and encourage independent judgement.

While the title of this article might suggest otherwise, we do recognize the value of multidisciplinary methods in managing complex diseases through joint planning and evidence-based decision-making. However, these approaches are not universal remedies. A major hurdle in healthcare is tailoring decisions and delivering comprehensive, patient-centred care. A sole reliance on multidisciplinary strategy may be inadequate, as it broadens care options without ensuring appropriateness. Guidelines, although helpful in standardizing care and reducing variability, are sometimes constrained by incomplete evidence. In this regard, we think that an interdisciplinary approach—rather than a multidisciplinary one—would be more suitable, as it integrates different expertise rather than just combining separate, discipline-specific insights.^{16, 17}

However, simply having a diversity of opinions is insufficient; there is a critical need for more clinical research, especially pragmatic trials. These trials blend experimental insights with real-world scenarios, enriching guidelines with nuanced evidence. This research is crucial not only for fostering a deeper understanding of patient-specific needs but also for refining healthcare decision-making, enhancing its relevance, accuracy and practical viability in real-life scenarios.

CONFLICT OF INTEREST STATEMENT

The authors do not have any disclosures to report.