title: Patient clinical profiles associated with physician non-compliance despite the use of a guideline-based decision support system: a case study with OncoDoc2 using data mining techniques.
abstract: OncoDoc2 is a guideline-based clinical decision support system (CDSS) applied to the management of breast cancer patients. OncoDoc2 has been routinely used during multidisciplinary staff meetings at the Tenon Hospital (Paris, France) for nearly 3 years. Despite the use of the CDSS that reminds physicians of the recommended treatments, the compliance rate of decisions is not 100%. We have used pattern mining techniques in order to elicit patient clinical profiles associated with non-compliance. We quantified each extracted pattern by three measures (support, growth rate, and unexpected rate) and we introduced a score to prune relevant emerging patterns. Non-compliance has concerned elderly patients in pre-surgery decisions, patients with micro invasive tumor in re-excision decisions, and patients HR+ and Her2+ in adjuvant decisions. In all cases, physician non-compliance with guidelines occurs when scientific evidence is lacking.
authors.affiliation: UPMC, UFR de Médecine, Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Séroussi
authors.forename: Arnaud
authors.initials: A
authors.lastname: Soulet
authors.forename: Nizar
authors.initials: N
authors.lastname: Messai
authors.forename: Cédric
authors.initials: C
authors.lastname: Laouénan
authors.forename: France
authors.initials: F
authors.lastname: Mentré
authors.forename: Jacques
authors.initials: J
authors.lastname: Bouaud
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D057225:Data Mining; D020000:Decision Support Systems, Clinical; D005103:Expert Systems; D019983:Guideline Adherence; D006801:Humans; D055641:Mathematical Concepts; D010820:Physicians; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant