A Novel Evidence-Adaptive Computerised Decision Support System for Breast Cancer Multidisciplinary Meetings: Results of an Evaluation Study.

Abstract

Abstract Background: Multidisciplinary meetings (MDM) also known as multidisciplinary cancer conferences are a forum for providing evidence-based care and are widely accepted as a part of standard cancer care worldwide. In United Kingdom, it is a mandatory requirement that the care of all breast cancer patients is managed through breast MDMs. However the lack of required support for conducting MDM is documented in many recent reviews. Advanced Computerised Decision Support (CDS) technology can play an important role in supporting MDMs and improving its functioning. We present a novel breast MDM support tool which integrates a CDS system into an electronic patient record to assist breast Multi Disciplinary Team (MDT) in making an evidence based, transparent treatment decisions during MDM. To the best of our knowledge there are no published studies of implementing computerised decision support systems for breast MDM.Methods: The Multi-disciplinary meeting Assistant and Treatment sElector (MATE) is a tool designed to assist breast clinicians in making management decisions for their patients in MDM. MATE is developed using a PROforma CDS technology which is funded by the Cancer Research UK. The tool is implemented in the breast unit of Royal Free hospital, London for its pilot testing. MATE evaluates patient's clinical facts and suggests optimal management options according to incorporated national and international clinical guidelines. The evidence base used in MATE can be updated as and when new evidence is published. MATE recommendations are not binding and the final decision is taken by breast MDT. MATE facilitates the flexible conduct of MDM. Additionally, it highlights if the patient is eligible to take part in any local, national or international clinical trials. In the evaluation study, the data of 300 consecutive breast patients presented at the Royal Free breast MDM along with their documented MDM recommendations are entered in MATE. MDM recommendations and MATE suggestions are analysed.Results: MATE system is able to suggest the treatment recommendations in concordance with breast MDT in most of the cases (91 %). MATE suggested more management options per patient than the documented MDT recommendations (3.4% vs. 1.2 %). MATE also identified 65% more patients suitable for ongoing clinical trials. Deviations that occur specially in unaided MDMs can be minimised using electronic data capture and decision support system like MATE.Conclusion: This evaluation study has shown the feasibility of implementing MATE into MDM and its potential to improve certain aspects of MDM by helping overburdened clinicians. The evidence adaptive decision support component of MATE can improve the guideline-compliance and transparency in the decision-making and also identify more patients to be considered for recruitment in clinical trials. Another important benefit could be completeness of documentation. Further evaluations of MATE in a randomised controlled trial are under way. If found beneficial, the system could easily be adapted for other cancers. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5118.