As a part of CREDO project we are developing a repository of computer-interpretable medical knowledge applications to deliver point-of-care decision support services in breast cancer. We follow a publishing life cycle that has been developed for the creation, dissemination, open review and revision of these applications. A number of applications have been developed and are in the various stages of this life cycle.
MATE: The Multi-disciplinary meeting Assistant and Treatment sElector
The first clinical-strength application is MATE, a system designed to support evidence-based, collective decision-making in breast cancer multidisciplinary team meetings. MATE is in routine clinical use at the Royal Free NHS Trust in London where it is also the subject of a randomised controlled trial designed to explore the extent to which the system can help improve compliance with evidence-based best practice.
MATE evaluates patient’s clinical facts and suggests optimal management options compliant with high quality evidence based clinical guidelines. However, suggestions made by the system are not binding and the final decision is taken by clinicians who can override the system. Additionally, the system is designed to ensure that clinicians are notified if a patient is eligible to take part in any national clinical trials.
Familial Breast Cancer Risk Assessment Tool
The Familial Breast Cancer Risk Assessment Tool is a computer interpretable guideline for the assessment and management of familial breast cancer risk based on the NICE guideline, Familial breast cancer: the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care, published in October 2006.
A prospective study of this tool is planned to be carried out at the Royal Free NHS Trust family history clinic.
Triple Assessment: Decision support for the initial assessment of patients with suspected breast cancer
The Triple Assessment Decision Support (TADS) system was developed with two main aims: to investigate whether computer-enacted guidelines can significantly enhance breast clinicians' compliance with best practice, and to collect feedback on system usability.
Early Referral for Cancer
This application provides decision support to GPs on whether to refer adult patients with suspected cancers to specialist clinical teams. The system is based on the Referral guidelines for suspected cancer published by the National Institute for Health and Clinical Excellence (NICE) in June 2005 and covers the following cancers:
Dukes B adjuvant chemotherapy risk prognostication tool
Decision support system designed to provide individualised risk prognostication in postoperative chemotherapy treatment of Dukes B stage patients with bowel cancer.
Decision support for breast cancer chemotherapy prescribing
This demonstrator system is designed to recommend, on the basis of clinical data, a personalised and evidence-based chemotherapy treatment plan for women with breast cancer.