Role and Characteristic of Multidisciplinarity in Hepatocellular Carcinoma Management and Care Pathway Certification: Bottom-Up Approach of the MDT Project in Italy

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, requiring a multidisciplinary approach for effective management. The MDT Project aimed to define and pilot a structured care model for HCC management in Italy, supported by the implementation of integrated care pathways (ICPs), to standardize organizational processes and ensure the organizational requirements needed for appropriate patient management. Methods: A multi-phase approach included a narrative review, semi-structured interviews with national experts, and the development of an optimal care model operationalized through a maturity model with 15 organizational elements. A total of 13 hospitals, selected to reflect national heterogeneity, participated in a pilot phase involving tailored action plans and hospital-specific ICPs. In total, ten hospitals proceeded to ICP implementation, and eight achieved certification by an external accreditation body. An expert consensus meeting subsequently validated the care model, key performance indicator (KPI) panel, and assessment tools. Organizational changes were assessed pre- and post intervention through the maturity model evaluation and a survey capturing clinicians' perceptions. Results: Organizational improvements were observed primarily in areas directly targeted by the action plans, including the formalization of care-flow processes, multidisciplinary team structuring, case management, and coordination processes. More limited progress was seen in information systems and KPI monitoring, which require structural investments. Clinicians perceived the certification process as helpful in consolidating procedural standardization and documentation quality. Conclusions: The MDT Project piloted an organizational model for HCC management in Italy, focusing on care-pathway governance, multidisciplinary coordination, and center readiness. These findings represent an initial step toward broader implementation; future phases should incorporate clinical outcomes and patient-reported measures to evaluate the model's long-term impact.