title: Using OncoDoc as a computer-based eligibility screening system to improve accrual onto breast cancer clinical trials.
abstract: 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.
authors.affiliation: Research Mission for Medical Information Science and Technology, Department of Applied Projects, Direction of Information Systems, Assistance Publique-Hôpitaux de Paris, 91 boulevard de l'Hôpital, 75634 Paris 13, France. bs@biomath.jussieu.fr
authors.forename: Brigitte
authors.initials: B
authors.lastname: Séroussi
authors.forename: Jacques
authors.initials: J
authors.lastname: Bouaud
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000628:therapy*; D002986:Clinical Trials as Topic; D003658:Decision Making, Computer-Assisted; D004608:Eligibility Determination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D018579:Patient Selection; D010819:Physician's Role; D010817:Physician-Patient Relations