A mixed methods study of multidisciplinary team assessment and therapeutic decision making for intestinal strictures in Crohn’s disease

Crohn's disease (CD) is frequently complicated by intestinal strictures, which substantially affect patients quality of life and long-term outcomes. Accurate classification of strictures-as inflammatory, fibrotic, or mixed-is critical for selecting optimal therapeutic strategies. In clinical practice, multidisciplinary team (MDT) consultation is often employed to assess stricture characteristics. However, the accuracy and inter-specialty consistency of stricture evaluation within MDTs remain inadequately characterized. This study aimed to assess the intra-disciplinary consistency and accuracy of decision-making for CD-related strictures, evaluate the accuracy of post MDT decisions, and propose recommendations for stricture nature assessment and MDT workflow optimization. A mixed-methods study was conducted at Peking Union Medical College Hospital involving 42 patients with CD and intestinal strictures. MDT participants-including specialists from gastroenterology, surgery, ultrasound, and MDT meeting chairs-were involved in evaluating intra-disciplinary decision consistency and accuracy. Semi-structured qualitative interviews were also conducted to explore factors influencing clinical decision-making. Gastroenterologists demonstrated the highest intra-team consistency (PABAK = 0.75) and diagnostic accuracy (89.3%). Ultrasound specialists showed improved consistency following targeted training (from 0.46 to 0.93). The overall accuracy of historical MDT decisions was 92.9%. Key factors influencing stricture nature judgment included clinical presentation, laboratory findings, imaging features, and endoscopic evaluation. Seven core components were identified to improve MDT workflow: expert selection, team building, training, pre-meeting preparation, in-meeting procedures, post-meeting actions, and continuous quality improvement. This study reveals variability in decision-making for CD-related strictures across different specialties. To improve diagnostic accuracy and treatment planning, we propose clear stricture classification criteria and a structured MDT workflow to standardize and enhance multidisciplinary management of CD.