title: Evidence-based guidelines and decision support services: A discussion and evaluation in triple assessment of suspected breast cancer.
abstract: Widespread health service goals to improve consistency and safety in patient care have prompted considerable investment in the development of evidence-based clinical guidelines. Computerised decision support (CDS) systems have been proposed as a means to implement guidelines in practice. This paper discusses the general concept in oncology and presents an evaluation of a CDS system to support triple assessment (TA) in breast cancer care. Balanced-block crossover experiment and questionnaire study. One stop clinic for symptomatic breast patients. Twenty-four practising breast clinicians from United Kingdom National Health Service hospitals. A web-based CDS system. Clinicians made significantly more deviations from guideline recommendations without decision support (60 out of 120 errors without CDS; 16 out of 120 errors with CDS, P < 0.001). Ignoring minor deviations, 16 potentially critical errors arose in the no-decision-support arm of the trial compared with just one (P = 0.001) when decision support was available. Opinions of participating clinicians towards the CDS tool became more positive after they had used it (P < 0.025). The use of decision support capabilities in TA may yield significant measurable benefits for quality and safety of patient care. This is an important option for improving compliance with evidence-based practice guidelines.
authors.affiliation: Advanced Computation Laboratory, Cancer Research UK, London WC2A 3PX, UK. vp@acl.icnet.uk
authors.forename: V
authors.initials: V
authors.lastname: Patkar
authors.forename: C
authors.initials: C
authors.lastname: Hurt
authors.forename: R
authors.initials: R
authors.lastname: Steele
authors.forename: S
authors.initials: S
authors.lastname: Love
authors.forename: A
authors.initials: A
authors.lastname: Purushotham
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Thomson
authors.forename: J
authors.initials: J
authors.lastname: Fox
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D018592:Cross-Over Studies; D003658:Decision Making, Computer-Assisted; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic