| Clinical
applications projects |
 OncoDoc |
| Decision support system
for the management of breast cancer |
| keywords |
main objectives |
| Evidence-based
medicine, clinical practice guidelines, knowledge representation,
decision trees
|
Development
and evaluation of a guideline-based decision support-system
for the management of breast cancer.
|
| clinical domains |
| Breast cancer
|
| description |
| OncoDoc
is a decision support system designed to provide
best therapeutic recommendations for breast cancer
patients.
OncoDoc combines two technical approaches:
decision trees and hypertext. The system is not designed to be
run as an executable program; the user browses clinical knowledge represented as decision
trees and the relevant patient data.
OncoDoc has also been used as a computer-based eligibility
screening system in breast cancer clinical trials.
For more details, see abstracts below.
|
|
| references |
Seroussi B, Bouaud J. Using
OncoDoc as a computer-based eligibility screening
system to improve accrual onto breast cancer clinical
trials. Artif Intell Med. 2003 Sep-Oct;29(1-2):153-67.
[PubMed]
[] |
" While clinical trials
offer cancer patients the optimum treatment, historical
accrual of such patients has not been very successful.
OncoDoc is a decision support system designed
to provide best therapeutic recommendations for
breast cancer patients. Developed as a browsing
tool of a knowledge base structured as a decision
tree, OncoDoc allows physicians to control the
contextual instantiation of patient characteristics
to build the best formal equivalent of an actual
patient. Used as a computer-based eligibility
screening system, depending on whether instantiated
patient parameters are matched against guideline
knowledge or available clinical trial protocols,
it provides either evidence-based therapeutic
options or relevant patient-specific clinical
trials. Implemented at the Gustave Roussy Institute
and routinely used at the point of care during
a 4-month period, it significantly improved physician
compliance with guideline recommendations and
enhanced physician awareness of open trials while
increasing patient enrollment to clinical trials
by 50%. But, when analyzing reasons of non-accrual
of potentially eligible patients, it appeared
that physicians' psychological reluctance to refer
patients to clinical trials, measured during the
experiment at 25%, may not be resolved by the
simple dissemination of clinical trial information
at the point of care. "
|
Bouaud J, Seroussi B. Impact
of site-specific customizations on physician compliance
with guidelines. Stud Health Technol Inform. 2002;90:543-7.
[PubMed]
[] |
" Developed and implemented
in the Service d'Oncologie Medicale Pitie-Salpetriere
(Paris, France) as a computer-based guideline
system on breast cancer, OncoDoc has already demonstrated
high physician compliance rates. To assess how
the system could be reused in another institution
which was not involved in the development process,
we have conducted a new experimentation at the
Institut Gustave Roussy. Minor site-specific customizations
of the knowledge base have been performed. After
four months, 127 cases were recorded. Results
showed that there was no significant difference
of physician compliance with OncoDoc (85%) when
site-specific recommendations were, or not, available,
although local recommendations were chosen preferably
(55%), thus legitimating the adaptation. "
|
| Bouaud J, Seroussi B, Antoine
EC, Zelek L, Spielmann M. A before-after study
using OncoDoc, a guideline-based decision support-system
on breast cancer management: impact upon physician
prescribing behaviour. Medinfo. 2001;10(Pt 1):420-4.
[PubMed]
[]
|
" Guideline-based decision
support systems have been developed to influence
the prescribing behaviour of clinicians, but they
have not yet shown to increase physician compliance
with best practices in routine. OncoDoc is a non-automated
system that allows flexibility in guideline interpretation
to obtain best patient-specific recommendations
at the point of care. OncoDoc is applied to breast
cancer management. We have experimented the system
at the Institut Gustave Roussy with a before-after
study in which treatment decisions for breast cancer
patients were measured before and after using the
system in order to evaluate its impact upon physicians'
prescribing behaviour. After 4 months, 127 decisions
were recorded. Physicians compliance with OncoDoc
was significantly improved (p < 10(-4) ) to reach
85.03% after using the system. Comparison of initial
and final decisions showed that physicians modified
their prescription in 31% of the cases. Clinical
trial accrual rate increased of 50%, though not
statistically significant because estimated on small
figures. "
|
| Seroussi B, Bouaud J, Antoine
EC. ONCODOC: a successful experiment of computer-supported
guideline development and implementation in the
treatment of breast cancer. Artif Intell Med. 2001
Apr;22(1):43-64.
[PubMed]
[sciencedirect.com]
|
" Originally published as textual
documents, clinical practice guidelines have poorly
penetrated medical practice because their editorial
properties do not allow the reader to easily solve,
at the point of care, a given medical problem. However,
despite the proliferation of implemented clinical
practice guidelines as decision support systems
providing an easy access to patient-centered information,
there is still little evidence of high physician
compliance to guidelines recommendations. Apart
from physicians' psychological reluctance, the incompleteness
of guideline knowledge and the impreciseness of
the terms used, another reason may be that, although
suited to average patients, clinical practice guideline
recommendations are not a substitute for the physician-controlled
clinical judgement that should be applied to each
actual individual patient. Therefore, computer-based
approaches based on the automation of context-free
operationalization of guideline knowledge, although
providing uniform optimal strategies to problem-focused
care delivery, may generate inappropriate inferences
for a specific patient that the physician does not
follow in practice. Rather than providing automated
decision support, ONCODOC allows the clinician to
control the operationalization of guideline knowledge
through his hypertextual reading of a knowledge
base encoded as a decision tree. In this way, he
has the opportunity to interpret the information
provided in the context of his patient, therefore,
controlling his categorization to the closest matching
formal patient. Experimented in life-size ONCODOC
demonstrated good appropriation of the system by
physicians with significantly high scores of compliance.
We successfully tested the implemented strategy
and the knowledge base in a second medical institution,
giving then a noticeable example of reuse and sharing
of encoded guideline knowledge across institutions.
"
|
| Seroussi B, Bouaud J, Antoine
EC. Users' evaluation of OncoDoc, a breast cancer
therapeutic guideline delivered at the point of
care. Proc AMIA Symp. 1999;:384-9.
[PubMed]
[paper
- AMIA] |
" Despite the dissemination of
computer-based "clinical practice guidelines" as
decision support systems, low practical compliance
rates are still observed. The reason commonly invoked
is that such recommendations, suited to average
patients, are not rules for all the patients. Rather
than providing automatic decision support, OncoDoc
allows the clinician to operationalize the implemented
breast cancer therapeutic expertise through his
hypertextual reading of the knowledge base. In this
way, he has the opportunity to interpret the information
provided in the context of his patient therefore
controlling his categorization to the closest appropriate
"average patient". After a four-month real-life
experimentation of the system, a survey was conducted
among the users. The observed compliance, significantly
higher than the best figures found in the literature,
and the clinicians objective and subjective evaluation
of the system reinforced the implementation choices
adopted in OncoDoc. "
|
|
| start date |
end date |
location |
support |
| |
|
France |
|
| contact |
links |
Brigitte Séroussi
brigitte.seroussi sap.ap-hop-paris.fr
Jacques Bouaud
jacques.bouaudsap.ap-hop-paris.fr
STIM/DSI/AP-HP
Bâtiment Blaise Pascal
Hôpital Broussais
96 rue Didot
75014 PARIS, France
|
|
| acknowledgements |
| Brigitte Séroussi, Jacques Bouaud |
Entry in directory: May
12 2004
Last main update: June 04 2005 |
|
|
