title: Impact of an Interactive On-line Tool on Therapeutic Decision-Making for Patients with Advanced Non-Small-Cell Lung Cancer.
abstract: BACKGROUND
  Treatment guidelines provide recommendations but cannot account for the wide variability in patient-tumor characteristics in individual patients. We developed an on-line interactive decision tool to provide expert recommendations for specific patient scenarios in the first-line and maintenance settings for advanced non-small-cell lung cancer. We sought to determine how providing expert feedback would influence clinical decision-making.
  
  
  METHODS
  Five lung cancer experts selected treatment for 96 different patient cases based on patient and/or tumor-specific features. These data were used to develop an on-line decision tool. Participant physicians entered variables for their patient scenario with treatment choices, and then received expert treatment recommendations for that scenario. To determine the impact on decision-making, users were asked whether the expert feedback impacted their original plan.
  
  
  RESULTS
  A total of 442 individual physicians, of which 88% were from outside the United States, entered 653 cases, with report on impact in 389 cases. Expert feedback affected treatment choice in 73% of cases (23% changed and 50% confirmed decisions). For cases with epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) fusion, all experts selected targeted therapy whereas 51% and 58% of participants did not. Greater variability was seen between experts and participants for cases involving EGFR or ALK wild-type tumors. Participants were 2.5-fold more likely to change to expert recommended therapy for ALK fusions than for EGFR mutations (p = 0.017).
  
  
  CONCLUSIONS
  This online tool for treatment decision-making resulted in a positive influence on clinician's decisions. This approach offers opportunities for improving quality of care and meets an educational need in application of new therapeutic paradigms.
authors.affiliation: *Department of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA; †Department of Internal Medicine, University of Maryland, College Park, MD; ‡Department of Oncology, Lombardi Comprehensive Cancer Center of the Georgetown University, Washington, DC; §Department of Biostatistics, University of California, Davis, CA; ‖Division of Medical Oncology, Swedish Cancer Institute, Seattle, WA; ¶Department of Internal Medicine, Swedish Cancer Institute, Seattle, WA; #Department of Internal Medicine, Comprehensive Cancer Center, University of California, Davis, CA.
authors.forename: Helen
authors.initials: H
authors.lastname: Chow
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Edelman
authors.forename: Giuiseppe
authors.initials: G
authors.lastname: Giaccone
authors.forename: Suresh S
authors.initials: SS
authors.lastname: Ramalingam
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Quill
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bowser
authors.forename: Jim
authors.initials: J
authors.lastname: Mortimer
authors.forename: Wilma
authors.initials: W
authors.lastname: Guerra
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Beckett
authors.forename: Howard L
authors.initials: HL
authors.lastname: West
authors.forename: Primo N
authors.initials: PN
authors.lastname: Lara
authors.forename: David R
authors.initials: DR
authors.lastname: Gandara
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003657:Decision Making; D006801:Humans; D020407:Internet; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D017216:Telemedicine