Interactive Decision Support Tool Research Articles

Comparison of expert treatment recommendations versus community healthcare providers: Analysis from an online decision support tool for metastatic breast cancer.

1053 Background: Management of metastatic breast cancer (MBC) is quickly evolving. Beyond hormone receptor (HR) status, a growing list of molecular markers are used to refine individualized systemic treatment (Tx). However, the number of options increases the complexity of Tx decision-making for healthcare professionals (HCPs). Here, we report an analysis of discordance between expert Tx recommendations vs HCPs from an online Interactive Decision Support Tool (IDST). Methods: Five breast cancer experts provided Tx recommendations for 59 unique MBC case scenarios where systemic therapy was indicated. Case scenarios were defined by key characteristics, including HR status, previous Tx, prior duration of response, and actionable biomarkers. After HCPs (n = 91) selected specific patient (pt) criteria and their intended Tx, the IDST showed the breast cancer experts’ recommendations, and HCPs were then asked whether seeing the recommendations changed their intended Tx plan. Experts’ recommendations were compared with that of HCPs to assess for concordance or discordance. Results: For first-line (1L) HR+/HER2- MBC, all experts (100%) recommended endocrine therapy with CDK4/6 inhibitor vs 38% of HCPs. For 1L HER2+ MBC, 62.5% concordance was observed with HCPs selecting expert recommended docetaxel, trastuzumab, and pertuzumab (THP). For 1L therapy for triple negative breast cancer (TNBC) based on BRCA1/2mutation and/or PD-L1 status, 44% of HCPs indicated they were uncertain of optimal Tx. Discordant findings were also observed for pretreated pts. For pretreated HR+/HER2- MBC, <50% of HCPs selected expert-recommended elacestrant for ESR1 mutant disease and chemotherapy (CT) if <12 months of prior response to 1L Tx vs 100% of experts. Moreover, 2 out of 5 HCPs agreed with experts in recommending T-DXd in pretreated HER2-low MBC. In pretreated HER2+ MBC, 100% of experts chose T-DXd vs 60% of HCPs if previous THP and no brain metastases, and 60% of experts vs 40% of HCPs chose T-DXd if brain metastases. In recurrent TNBC with no actionable biomarkers and ≥2 previous systemic CT, 7% of HCPs selected sacituzumab govitecan vs all experts selecting this Tx or CT not previously received. Overall, 50% and 29% of HCPs indicated expert recommendations changed or confirmed their practice, respectively. Conclusions: Data from an online IDST demonstrate discordance of expert recommendations and community HCPs Tx selection in MBC, which is made challenging by a number of variables that that must be assessed during the care continuum. Expert recommendations in the IDST often reinforced or changed HCP’s Tx plan, highlighting the need for ongoing education and the potential of an online tool to improve optimal Tx decisions for MBC, particularly when HCPs must consider current guidelines and tumor-specific biomarkers across multiple tumor types they may see.

Treatment patterns among HCPs and concordance with expert recommendations in HER2-negative early breast cancer: Analysis of an interactive online treatment decision support tool.

e13601 Background: Management of HER2- EBC continues to evolve with expansion of targeted therapies, including abemaciclib, olaparib, and pembrolizumab, in the adjuvant setting for eligible pts. We sought to identify contemporary practice patterns among HCPs for HER2- EBC and compare them with those of experts using an online interactive decision support tool. Methods: An online decision support tool was developed with input from 5 BC experts to provide tx recommendations for 19 unique pt case scenarios based on considerations including subtype, tx history, and recurrence risk. HCPs entered specific patient criteria along with their intended management for that case, and then were shown 5 expert recommendations. HCPs were asked if the recommendations impacted their intended approach. An analysis of expert recommendations and HCP-selected tx was performed. Results: Between Oct 2023 and Jan 2024, 83 HCPs entered 105 cases. Of the 97 cases where HCPs noted a definitive tx plan, recommendations were discordant from experts in 29%. The most commonly queried cases, expert recommendations, and discordance between HCPs and experts are outlined in the table. Discord with experts was similar among HCP tx plans for cases of TNBC (33%) and HR+/HER2- EBC (27%). HCPs predominantly sought guidance for pts with HR+/HER2- EBC, no g BRCAm, and high-risk disease per monarchE trial criteria (79%), with 22% discordance from expert recommendations. Regardless of BC subtype, the highest level of discord between HCPs and experts (67%) was observed in cases where pts had received neoadjuvant tx and had no residual disease following surgery, although this represents a small subset (n = 12). When asked if the expert recommendations changed their tx choice, 7 of 27 (26%) HCPs who responded indicated that expert recommendations changed their intended tx, whereas 15% noted that there were barriers to implementing those recommendations. Conclusions: These data suggest ongoing challenges with incorporating the newest targeted therapies for high-risk EBC management. Continued education and development of resources for HCPs, including online decision support tools, may be increasingly important as the treatment of EBC continues to evolve. [Table: see text]

Contemporary management of patients with advanced melanoma: Utility of an online interactive decision support tool to assess concordance of healthcare professional treatment patterns with expert recommendations.

e13548 Background: The treatment landscape for patients with melanoma continues to evolve with approvals of novel therapeutic agents for advanced disease and new indications for therapy in earlier-stage disease. Using an online decision support tool, we compared practice patterns and treatment recommendations between community healthcare professionals (HCPs) and key opinion leaders (KOLs). Methods: The online decision support tool was developed with input from 5 KOLs who provided treatment recommendations for 151 hypothetical patients. Case scenarios covered a spectrum of stages (III, IV), central nervous system (CNS) metastases, BRAF mutation status, and treatment histories. HCPs entered specific patient criteria into the tool to define a case and their intended therapy choice and the tool then showed 5 KOL recommendations for that patient case. An analysis of KOL recommendations and HCP-selected therapy was performed. Results: Between August 2023 and January 2024, 156 patient cases were entered by 100 HCPs. HCP and KOL recommendations were concordant in 51% (80/156) of cases. The highest level of discord among HCPs and KOLs was 72% for patients with completely resected stage IIIA melanoma and no positive lymph nodes having a metastatic focus ≥1mm (n = 25) (Table). A lower level of discordance (31%, n = 35) was observed in therapy selection for patients with stage IIIA melanoma and ≥1 positive lymph node. For first-line therapy in patients with unresectable stage III or IV BRAF wild-type melanoma (n = 16), discordance was 50% between HCPs and KOLs. The level of discordance was higher for first-line therapy for patients with BRAF-mutant melanoma (68%, n = 19). For the management of patients with CNS metastases, 40% of HCP therapy selections were not aligned with KOLs (n = 40). More than one half (56%) of HCPs noted that the tool confirmed their treatment plan, and 21% intend to change practice to align with KOLs. Conclusions: This analysis identified areas of discordance in clinical practice between HCPs and KOLs for advanced melanoma that can guide further education and enhance communication of evolving evidence to HCPs. Our data suggest that use of the decision tool can confirm best practices with KOL recommendations and improve alignment of treatment choices with KOLs. [Table: see text]

Analysis of healthcare provider management of immune-related adverse events and concordance with NCCN Guidelines.

11136 Background: Immune checkpoint inhibitors (ICIs) are a mainstay of treatment for many cancers but can cause immune-related adverse events (irAEs) that require prompt recognition and management. In 2017, we developed an online interactive decision support tool [www.clinicaloptions.com/immuneAEtool] for healthcare providers (HCPs) with case-specific recommendations for managing irAEs from a medical oncology expert. In 2019 and 2023, we updated the tool to offer recommendations from the latest National Comprehensive Cancer Network (NCCN) Guidelines. Here, we report a comparison of self-reported irAE management from HCPs using the 2023 tool vs NCCN recommendations and a comparison of practice patterns between the 2023 and 2019 tools. Methods: To use the online tool, HCPs entered the affected organ system, symptom grade/severity, and their planned management strategy. The tool showed the NCCN management recommendation for that irAE and then asked if the recommendation changed their intended management approach. Results: From July to December 2023, 172 HCPs entered 241 case scenarios into the tool; 53% treated <10 patients/month with ICIs, and 38% of HCPs practiced in the United States. The most common irAEs involved the gastrointestinal (GI)/hepatobiliary (hep)/pancreatic (29% of cases) or dermatologic/oral (19%) systems. Overall, the planned irAE management strategy of HCPs matched the NCCN recommendations in 55% of cases, an increase from the 49% concordance rate in our 2019 analysis. In the current analysis, the lowest concordance was observed for infusion-related reactions (20%), musculoskeletal irAEs (46%), and dermatologic/oral mucosa irAEs (46%; Table). Furthermore, US HCPs had a lower overall concordance rate (46%) than non-US HCPs (66%). Approximately one half (56%) of all HCPs indicated that the NCCN recommendations in the tool changed their management plan. Conclusions: These data suggest that many HCPs are challenged to optimally manage irAEs and are not managing their patients in concordance with NCCN guidelines. A detailed analysis of HCP irAE management vs NCCN recommendations, including by organ system and severity, along with a comparison of 2023 vs 2019 practice patterns, will be presented. [Table: see text]

Abstract PO2-10-08: Contemporary HER2-Positive MBC Treatment Recommendations Among Community Healthcare Professionals: Analysis of an Online Interactive Decision Support Tool

Abstract Background: The management of HER2-positive (HER2+) metastatic breast cancer (MBC) has continued to evolve, with multiple FDA approvals of novel HER2-targeted agents since late 2019. Considering the growing HER2+ MBC treatment armamentarium, we sought to identify current practice patterns among community healthcare professionals (HCPs) for HER2+ MBC by comparing HCP and key opinion leader (KOL) treatment recommendations using an online decision support tool. Methods: An online decision support tool was developed with input from 5 KOLs to provide therapy recommendations for 630 HER2+ MBC patient case scenarios based on conventional considerations including distribution of metastatic disease, treatment history, duration of response, and specific comorbidities. HCP tool users entered specific patient criteria to define a case along with their intended management for each case. The tool then showed 5 KOL recommendations for the user-entered patient case, and the users were asked to indicate if the expert recommendations confirmed or changed their intended approach. An analysis of expert recommendations and user-selected therapy was performed. Results: Between November 2022 and July 2023, 313 patient cases were entered by 242 participating HCPs. HCP and KOL treatment recommendations were frequently discordant (Table). For patients with de novo HER2+ MBC (n = 55), there was strong concordance (63%; P = .0001) between HCP and KOL recommendations. However, weak treatment selection concordance (53%; P < .0001) was observed for patients with disease progression after standard neoadjuvant/adjuvant therapy with chemotherapy plus HER2-targeted agents (n = 57). In the second-line setting, 43% concordance was observed for patients with non‒central nervous system (CNS) disease progression without CNS progression after first-line therapy with THP (n = 67; P < .0001), whereas 61% concordance was observed for patients with non-CNS and CNS disease progression after first-line therapy with THP (n = 61; P < .0001). In the third-line setting, 31% concordance was observed for patients with non-CNS disease progression without CNS progression (n = 32; P < .0001), and 47% concordance was observed for patients with non-CNS and CNS disease progression (n = 19; P = .0009). For HCPs whose treatment plan did not match KOL recommendations in these scenarios, 62% indicated that KOL recommendations confirmed or changed their intended therapy, but 19% indicated that there were barriers to implementing those recommendations. Conclusions: These data suggest ongoing challenges to optimally incorporate novel HER2-targeted therapies in the care of patients with HER2+ MBC, particularly in the second line and beyond, but an online tool providing KOL advice on specific patient scenarios confirmed or changed the clinical approach for a majority of HCPs. Thus, continued development of resources for HCPs, including online decision support tools, may be increasingly important given the rapidly evolving treatment landscape. Table. Summary of Treatment Choices by KOLs or HCPs for Select Patient Scenarios Citation Format: Kristen Rosenthal, Sara Hurvitz, Komal Jhaveri, Heather McArthur, Sara Tolaney, Timothy Quill. Contemporary HER2-Positive MBC Treatment Recommendations Among Community Healthcare Professionals: Analysis of an Online Interactive Decision Support Tool [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-08.

Visioning channel evolution for river management: Toward a functional decision support framework

AbstractImprovements in simulating and communicating the evolutionary trajectory of river morphology in response to environmental forcing over multi‐decadal timeframes would foreshadow the development of “foresight competency” in river management, whereby resource managers could strategically plan toward the most preferred of several plausible futures. Of the six steps in foresight competency, visioning, which involves translating scientific forecasts into a format useable by resource managers via a user‐friendly and interactive decision support tool that supports transparent decision‐making, is the least well developed. The approach requires converting forecasting model outputs into metrics of channel evolution that highlight transitions either within or between channel morphology states. Here, seven process‐based state transition metrics are proposed covering channel planform, morphological stability, corridor belt width, floodplain connectivity, bank erosion rate, bedform habitat diversity, and ecohydraulic diversity. To aid decision support, the metrics are converted into graphical indicators that are intuitive for management use and assembled into several prototype dashboard‐style graphical user interfaces designed to facilitate interactivity. A proof‐of‐concept illustration is provided and priorities in development toward a fully operational decision support tool are discussed. Such developments are critical in ensuring the practical relevance of geomorphology.

Contemporary Multiple Myeloma Treatment Patterns Among HCPs and Concordance with Expert Recommendations: Analysis of an Interactive Online Decision Support Tool

Background: The management of multiple myeloma (MM) continues to evolve with the emergence of new classes of therapy, most recently including BCMA-targeted therapies. Considering the expanding MM treatment armamentarium, we sought to identify contemporary practice patterns among healthcare professionals (HCPs) for MM and compare them with those of experts using an online decision support tool. Methods: An online decision support tool was developed with input from 5 experts providing therapy recommendations for 192 unique patient case scenarios based on considerations including disease setting, treatment history, access to therapy, and specific comorbidities. HCP tool users entered specific patient criteria to define a case along with their intended management for that case. The tool then showed the 5 expert recommendations for that same case scenario, and users were asked if the recommendations impacted their intended approach. An analysis of expert recommendations and user-selected therapy was performed. Results: Between April 2023 and July 2023, 207 patient cases were entered by 144 participating HCPs. HCP and expert treatment recommendations were frequently discordant, regardless of treatment setting (Table). The highest concordance between HCP and expert recommendations (47%; P <.0001) was in the induction setting (n = 111). In this setting, experts were more likely to recommend quadruplet regimens compared with HCPs (62% vs 27%, respectively; P <.0001). Treatment selection concordance was lower in the maintenance (n = 17; 24%; P <.0001) and relapsed/refractory settings (n = 79; 20%; P <.0001). The lowest concordance (10%; P <.0001) between HCP and expert treatment recommendations was noted in the relapsed/refractory setting specifically among patients who were refractory to earlier lines of therapy (n = 41; P <.0001). For patients who are refractory to earlier lines of therapy, experts were more likely to recommend an anti-CD38-based combination regimen compared with HCPs (81% vs 32; P <.0001). When recommending treatment for patients with triple- or penta-refractory disease, experts were significantly more likely to recommend BCMA-targeted agents (83% vs 39%; P <.0001). For HCPs whose treatment plan did not match expert recommendations in these scenarios, 53% of respondents indicated that expert recommendations confirmed or changed their intended therapy, but 31% indicated that there were barriers to implementing those recommendations. Conclusions: These data suggest ongoing challenges with incorporating the newest therapies and combinations across the spectrum of MM into patient care, particularly multidrug regimens in the induction and maintenance settings and BCMA-targeted therapies in those with triple- or penta-refractory disease. Continued education and development of resources for HCPs, including online decision support tools, may be increasingly important as the treatment of MM continues to grow in complexity.

A Novel Online Decision Support Tool to Determine Practice Patterns and Concordance with Experts in the Treatment of Patients with Immune Thrombocytopenia

Background: Immune thrombocytopenia (ITP) is a complex disease involving dysregulation of the immune system with inadequate platelet production and increased platelet destruction. When treatment is warranted, corticosteroids are frequently used as first-line therapy. Steroid-refractory patients eventually require alternative treatments, of which there are several approved and well-studied options. However, these second-line treatments have not been rigorously compared in clinical trials. To assist healthcare professionals (HCPs) in managing patients with ITP, we developed an online interactive decision support tool to provide expert recommendations for treatment. Here we report an analysis of practice patterns among HCPs and experts for ITP cases after initial therapy failure and the impact of expert recommendations on HCP decisions. Methods: An online tool was developed with 4 experts providing recommendations on management of 332 unique patient cases based on patient- and disease-specific factors that the experts considered relevant to making treatment decisions. HCPs entered patient case details including age, treatment setting, platelet count, current presentation, and presence of risk factors for bleeding, along with their intended management approach, before being shown the expert recommendations for their specific scenario. Results: Between October 2022 and July 2023, 311 patient cases were entered by 256 HCPs, including 194 (62.4%) cases of treatment-exposed patients (Table). Of the treatment-exposed cases, 72.1% were submitted by physicians, and 23.2% were submitted by HCPs in North America. There was strong alignment between HCP treatment selection and at least 1 expert recommendation (69%; P = .0001). There was consensus among experts for 94.4% of cases with patients ≥21 years of age who were treatment exposed. In these cases, experts recommended thrombopoietin receptor agonists (TPO-RA) for 83.5% of cases in contrast to HCPs recommending them in 38.2% of cases. Alternatives for TPO-RA chosen by HCPs in cases with patients ≥21 years of age who were treatment exposed included rituximab (29.6%), immunoglobulin (23.5%), fostamatinib (12.5%), splenectomy (9.8%), observation (8.6%), or unsure (16%). There was consensus among experts for 72% of cases with patients <21 years of age who were treatment exposed. For cases with patients <21 of age who were treatment exposed, HCPs chose immunoglobulin (28.6%), observation (28.6%), rituximab (14.3%), splenectomy (4.7%), or unsure (23.8%). In 47.6% of cases where HCPs indicated an alternative selection, they indicated that expert recommendations changed their treatment choice. HCPs indicated there were barriers to implementation in 7% of indicated cases. Conclusion: Based on our analysis of an online treatment decision tool, practice patterns for the management of patients with ITP aligned between HCPs and at least 1 tool expert in 69% of treatment-experienced cases. For previously treated patients, HCPs were less likely to choose a TPO-RA compared with tool experts, although very few identified barriers to implementation. Although specific treatment utilization patterns differed between HCPs and experts based on data from this tool, HCPs appeared amenable to practice changes based on expert recommendations. Online decision support tools can offer opportunities for HCPs to receive education and expert guidance in choosing optimal treatment regimens for ITP, a condition where treatment guidelines may not address every unique patient scenario.

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance

Abstract Background Antimicrobial resistance (AMR) is one of the most important public health threats. It is important for healthcare professionals (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to mitigate inappropriate antimicrobial use. This review identified existing interventions which aim to improve HCPs’ interaction with patients and examined factors that enables or hinders appropriate behaviours. Methods We searched MEDLINE, EMBASE, Science Citation Index, Social Sciences Citation Index, Google Scholar, internet and conducted forward and backward citation searching from eligible studies. We included studies of any design, published in English language from year 2010 to 2023. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation - Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Results We included 59 studies of diverse designs examining a range of interventions from 16 countries. Many interventions involved multiple components beyond HCPs’ interaction with patients, e.g., Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET). Patient interaction components mostly involved use of posters, leaflets, videos, interactive decision support tools and C reactive protein point-of-care testing. The interventions were often found to be useful. Barriers and facilitators identified related to capability (e.g., knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions, forgetfulness); opportunity (e.g., time constraint, intervention accessibility) and motivation (e.g., patient's desire for antibiotics, fear of litigation). Conclusions There are many useful interventions to improve HCPs and patients’ interactions for appropriate behaviours in antibiotic use. The barriers and facilitators identified in this review should be considered by intervention designers/adopters and policy makers to improve implementation and effectiveness. Key messages • Factors hindering appropriate antimicrobial use are complex. • This review can inform the development and implementation of strategies to improve healthcare professional’ interaction with the users.

Interpretation and use of a decision support tool for multiple treatment options: a combined randomised controlled trial and survey of medical students

ObjectivesTo investigate medical students’ ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence...

Promoting informed approaches in precision oncology and clinical trial participation for Black patients with cancer: Community-engaged development and pilot testing of a digital intervention.

Black patients with cancer are less likely to receive precision cancer treatments than White patients and are underrepresented in clinical trials. To address these disparities, the study aimed to develop and pilot-test a digital intervention to improve Black patients' knowledge about precision oncology and clinical trials, empower patients to increase relevant discussion, and promote informed decision-making. A community-engaged approach, including a Community Advisory Board and two rounds of key informant interviews with Black patients with cancer, their relatives, and providers (n=48) was used to develop and refine the multimedia digital intervention. Thematic analysis was conducted for qualitative data. The intervention was then pilot-tested with 30 Black patients with cancer to assess feasibility, acceptability, appropriateness, knowledge, decision self-efficacy, and patient empowerment; Wilcoxon matched pairs signed-rank test was used to analyze quantitative data. The digital tool was found to be feasible, acceptable, and culturally appropriate. Key informants shared their preferences and recommendations for the digital intervention and helped improve cultural appropriateness through user and usability testing. In the pilot test, appreciable improvement was found in participants' knowledge about precision oncology (z=-2.04, p=.052), knowledge about clinical trials (z=-3.14, p=.001), and decisional self-efficacy for targeted/immune therapy (z=-1.96, p=.0495). The digital intervention could be a promising interactive decision-support tool for increasing Black patients' participation in clinical trials and receipt of precision treatments, including immunotherapy. Its use in clinical practice may reduce disparities in oncology care and research. We developed a digital interactive decision support tool for Black patients with cancer by convening a Community Advisory Board and conducting interviews with Black patients with cancer, their relatives, and providers. We then pilot-tested the intervention with newly diagnosed Black patients with cancer and found appreciable improvement in participants' knowledge about precision oncology, knowledge about clinical trials, and confidence in making decisions for targeted/immune therapy. Our digital tool has great potential to be an affordable and scalable solution for empowering and educating Black patients with cancer to help them make informed decisions about precision oncology and clinical trials and ultimately reducing racial disparities.

Advanced cervical cancer therapy: Comparison of contemporary expert and healthcare professional recommendations from an online treatment decision tool.

5528 Background: Practice patterns for the management of advanced cervical cancer are rapidly evolving given the emergence of novel treatment options. We developed an online Interactive Decision Support Tool (IDST) for advanced cervical cancer to provide expert guidance to healthcare professionals (HCPs). Methods: With input from 5 experts, an IDST was developed for patient scenarios with newly diagnosed (ND) and recurrent/second-line (2L) advanced cervical cancer. The IDST included expert insights on 352 scenarios based on criteria such as adenopathy, disseminated disease status, previous therapy, and actionable biomarkers (PD-L1, MMR/MSI, TMB). Users were asked to enter specific patient criteria and their intended management approach. The IDST then showed the 5 expert recommendations for that specific scenario and HCPs were asked to indicate whether the recommendations changed their intended treatment plan. Expert recommendations vs user-selected therapy for different scenarios were analyzed. We present self-reported practice patterns in this disease setting and the impact of expert recommendations on treatment choice. Results: At this interim analysis, 141 unique learners used the IDST, entering 232 unique patient scenarios. Data from the IDST also showed areas of consensus and controversy in treating patients with advanced cervical cancer. For locally advanced, ND, no adenopathy and no metastases, all experts recommended pelvic chemoradiation with or without brachytherapy vs only 61% of HCPs; 16% and 3% of those entering cases for the locally advanced ND setting indicated expert recommendation changed their treatment choice and that barriers impeded the recommendations, respectively. For advanced ND, with adenopathy, metastatic, PD-L1–positive cervical cancers, all experts vs 50% of HCPs chose an immunotherapy-containing platinum-based chemotherapy regimen with/without bevacizumab; 9% of those indicated barriers to implementing expert recommendations. In 2L recurrent disease, all experts chose either single-agent immunotherapy (if PD-L1 positive) or tisotumab vedotin (if PD-L1 negative) vs 45% and 40% of HCPs, respectively; 19% of those selecting 2L therapy in the recurrent setting said the expert recommendations had changed their intended choice. Conclusions: Analysis from this IDST indicates differences in practice patterns between experts and HCPs for various case scenarios of advanced cervical cancer. Online decision support tools may increase the number of HCPs making optimal treatment decisions for advanced cervical cancer, particularly when new data, indications, and guideline updates must be considered. Updated and detailed analyses from the IDST will be presented.

Building an interactive web mapping tool to support distributed energy resource planning using public participation GIS

Community solar projects involve the installation of large PV systems whose net outputs are then virtually allocated to customers at other locations. They represent a relatively new model of distributed energy resource (DER) implementation that could help overcome some historical barriers to low-income, disadvantaged community, renter household participation in the ongoing renewable energy transition. Siting community solar assets is a thick and inherently geographic problem however, one which relates to historical patterns of energy infrastructure investment, local urban development, and community socio-demographic change. Creating a more equitable energy system will require planning tools which better coordinate the DER adoption decisions of individual property owners with the grid operators. Interactive decision support tools based on web maps are well suited to addressing this need for improved information sharing and coordination. However, such tools need to be designed and implemented through a process of public participation with stakeholders who explicitly focus on social and environmental justice. Here we describe the process by which one such tool was developed. We also report on several important findings derived from its use relating to current imbalances between local DER supply potential and the grid integration capacity limits which exist within Southern California's disadvantaged communities.

957. Interactive Antibiogram Decision Support Tool Predicated Upon Infection Site and Probable Pathogens

Abstract Background Current methods for displaying summary antibiograms are static, have limited utility and are not user friendly. We present an interactive web application for visualization of antibiogram data. Methods Antibiotic susceptibility data for first, non-duplicate patient infection isolates with source/site data were collected from 2009–2018 at an integrated health system for the visualizations. Iterative user-centered design sessions were held with healthcare providers to guide prototype development, including assessment of source groupings and rational for aggregating data. Three providers participated in initial and follow-up sessions (6 total) with study personnel. Data were aggregated by agreed-upon infection-source and pathogen; antibiotic results with < 30 isolates were excluded. Results The multi-year dataset included 119,333 non-duplicative isolates from 194 unique infection sites; nearly half were E. coli (n=50,404). Final infection source groupings with interactive data visualization fields are shown in Figure 1. First an infection source is selected; the visualization then shows pathogen prevalence in descending order. Providers can view susceptibility results for all antibiotics or deselect all and view only those under consideration, such as the four displayed in Figure 1. Resulting bar charts allow providers to view which pathogens tested have greater than 80% or 90% susceptibility to each antibiotic. Susceptibilities for multiple pathogens can also be visualized with the dodged feature (Figure 2). The large dataset collected supports source-specific susceptibility results (e.g. eye infections). The visualization allows providers to see how susceptibility by pathogen may cross clinically meaningful thresholds of 80% and 90% for different infection sources, such as urinary tract compared to bloodstream infections. Feedback from providers on the prototype was overwhelmingly positive. Figure 1.Visualization of urine isolates, E. coli and user selected antibiotics Final source groupings: Urine, Skin/Soft Tissue, Blood, Respiratory Secretions, Fluid, Ear, Bone, Vaginal/Perianal, Eye, and Abscess. Figure 2.Selected antibiotic susceptibilities for multiple pathogens can be visualized simultaneously with the dodged feature. Conclusion Our interactive antibiogram data clinical decision support tool extends the utility of the traditional lab-generated antibiogram. Importantly, future iterations will include visualizing changes by year, by clinical setting (inpatient vs. outpatient) and an assessment of uptake of this tool in the clinical setting. Disclosures All Authors: No reported disclosures.

Abstract A011: Effectiveness of an online decision support tool in communicating information about treatment options and related risks for ductal carcinoma in situ (DCIS)

Abstract Introduction: Treatment options for women diagnosed with DCIS require careful consideration of the potential risks and benefits. An interactive decision support tool (DST) was developed to provide information about these options, including their potential long-term risk. The DST was implemented through the website www.dcisoptions.org in collaboration with the AFT-25 Comparing an Operation to Monitoring, with or without Endocrine Therapy (COMET), for low-risk DCIS study. Methods: The DST provides personalized prediction of the potential clinical impact of six different treatment options over a 10-year period. Women were asked to select one or more option, and to complete two surveys - one prior to interacting with the DST and one following interaction. Chi-square tests were used to compare the distribution of age group and DCIS grade among women who completed both surveys and those who completed the pre-tool survey only. Mean age was compared using the t-test and median age was compared using the Wilcoxon-Mann-Whitney test. The signed-rank test was used to compare the median age. The cohort that answered both surveys was analyzed for potential differences in response (pre- versus post-tool). The McNemar test was used to compare percentage distributions and the paired t-test was used to compare mean responses for questions using the Likert scale. A signed rank test was used to compare median changes from pre- to post-tool. Statistical significance was defined as P<0.05 in a two-sided test. The primary endpoint of the study was to evaluate the effectiveness of the DST in communicating information about DCIS treatment options and related risk predictions. Results: Data were collected from January 2019 to April 2022 for women (non-COMET participants) who completed the DST. Of those 976 women, 831 (85%) completed the pre-tool survey only and 145 (15%) completed both the pre- and post-tool survey. The mean age was 54.4 (9.8 SD) years. 73% of women had low/intermediate-grade DCIS, while 19% had high-grade DCIS. Among women who submitted both surveys, average time spent completing the DST was 10 minutes. Awareness of the treatment options prior to use of the DST was high (90%), except for active surveillance (85.2%) and bilateral mastectomy (84.3%). Awareness post-tool did not change significantly except for active surveillance (85.2% to 96.5% (p=0.004)). Among women who completed both surveys, the percentage who correctly identified that the chance of dying from DCIS is ‘Very Low’ increased from 60.0% to 73.8% (p<0.0001). The median estimated risk of dying from DCIS in 10 years decreased from 9% to 3% (p<0.0001). A total of 101/132 (76.5%) women that responded to a specific question about the DST found it to be ‘Very Helpful’ or ‘Helpful’ in making a treatment decision for DCIS. A limitation of the study is the lower response rate to the post-tool survey. Conclusion: In this study, we demonstrated that utilization of a DST by women diagnosed with DCIS may enable value-congruent decision making and potentially result in improved patient outcomes. Citation Format: Thomas Lynch, Ann Partridge, E. Shelley Hwang, Alastair Thompson, Elizabeth Frank, Donna Pinto, Deborah Collyar, Desiree Basila, Terry Hyslop, Marc Ryser, Anna Weiss, Anna Rapperport, Rinaa Punglia, Elissa Ozanne. Effectiveness of an online decision support tool in communicating information about treatment options and related risks for ductal carcinoma in situ (DCIS) [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr A011.

An Open-Access, Interactive Decision-Support Tool to Facilitate Guideline-Driven Care for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is increasing in incidence and is a leading cause of cancer-related mortality worldwide. Adherence to HCC surveillance guidelines and appropriate treatment triage of liver lesions may improve receipt of curative-intent treatment and improved survival. Late-stage HCC diagnosis reflects sub-optimal implementation of effective HCC surveillance, whereas inappropriate treatment triage or linkage to care accounts for the non-receipt of curative-intent in close to half of early-stage HCC in the USA. A free, open-access decision-support tool for liver lesions that incorporates current guideline recommendations in a user-friendly interface could improve appropriate and timely triage of patients to appropriate care. This review provides a summary of gaps and disparities in linkage to HCC care and introduces a free, internet-based, interactive decision-support tool for managing liver lesions. This tool has been developed by the HCC Steering Committee of the Chronic Liver Disease Foundation and is targeted toward clinicians across specialties who may encounter liver lesions during routine care or as part of dedicated HCC surveillance.

Developing a Multilevel Decision Support Tool for Urban Mobility

Decisions on transport policy measures have long-term and important impacts on the economy, environment and society. Transport policy measures can lock up capital for decades and cause manifold external effects. In order to allow policymakers to evaluate transport policies, the developed decision support tool facilitates the evaluation of the multidimensional impacts of the implementation of transport policies. The objective of the decision support toolset presented in this paper is to support transportation planning and design practices based on an integrated transportation analysis of the area of examination to determine the most applicable combination of mobility services. This paper provides a comprehensive description of the interactive decision support tool implemented to help cities and decision makers design their strategies and shape the urban mobility of the future.

SubsidyExplorer: A decision-support tool to improve our understanding of the ecological and economic effects of reforming fisheries subsidies.

The magnitude of subsidies provided to the fishing sector by governments worldwide is immense—an estimated $35.4 billion USD per year. The majority of these subsidies may be impeding efforts to sustainably manage fisheries by incentivizing overfishing and overcapacity. Recognizing the threat these subsidies pose, the World Trade Organization has set a goal of reaching an agreement that would end fisheries subsidies that contribute to overcapacity, overfishing, and illegal fishing. However, negotiations have been hampered by uncertainty around the likely effects of reforming these subsidies. Here we present a novel method for translating a bioeconomic model into an interactive online decision support tool that draws upon real-world data on fisheries subsidies and industrial fishing activity so users can directly compare the relative ambition levels of different subsidy reform options.

Decision-support systems for ambulatory care, including pandemic requirements: using mathematically optimized solutions

BackgroundThe healthcare sector poses many strategic, tactic and operational planning questions. Due to the historically grown structures, planning is often locally confined and much optimization potential is foregone.MethodsWe implemented optimized decision-support systems for ambulatory care for four different real-world case studies that cover a variety of aspects in terms of planning scope and decision support tools. All are based on interactive cartographic representations and are being developed in cooperation with domain experts. The planning problems that we present are the problem of positioning centers for vaccination against Covid-19 (strategical) and emergency doctors (strategical/tactical), the out-of-hours pharmacy planning problem (tactical), and the route planning of patient transport services (operational). For each problem, we describe the planning question, give an overview of the mathematical model and present the implemented decision support application.ResultsMathematical optimization can be used to model and solve these planning problems. However, in order to convince decision-makers of an alternative solution structure, mathematical solutions must be comprehensible and tangible. Appealing and interactive decision-support tools can be used in practice to convince public health experts of the benefits of an alternative solution. The more strategic the problem and the less sensitive the data, the easier it is to put a tool into practice.ConclusionsExploring solutions interactively is rarely supported in existing planning tools. However, in order to bring new innovative tools into productive use, many hurdles must be overcome.

Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial

BackgroundDuring the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs’ underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree’s nodes step-by-step in an interactive manner.ObjectiveThis study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts.MethodsWe developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention’s guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants’ accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants’ ratings of the DSTs’ usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants’ perception of the tools. We used ANOVAs and t tests to assess statistical significance.ResultsOur survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7%, SD 14.1%; static DST group: mean 80.5%, SD 15.8%) compared to the control group (mean 65.8%, SD 20.8%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants’ perception of the DSTs.ConclusionsWhen the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other.Trial RegistrationDeutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered)