Clinical decision trees support systematic evaluation of multidisciplinary team recommendations

Abstract

Purpose EUSOMA's recommendation that "each patient has to be fully informed about each step in the diagnostic and therapeutic pathway" could be supported by guideline-based clinical decision trees (CDTs). The Dutch breast cancer guideline has been modeled into CDTs (www.oncog uide.nl). Prerequisites for adequate CDT usage are availability of necessary patient data at the time of decision-making and to consider all possible treatment alternatives provided in the CDT. Methods This retrospective single-center study evaluated 394 randomly selected female patients with non-metastatic breast cancer between 2012 and 2015. Four pivotal CDTs were selected. Two researchers analyzed patient records to determine to which degree patient data required per CDT were available at the time of multidisciplinary team (MDT) meeting and how often multiple alternatives were actually reported. Results The four selected CDTs were indication for magnetic resonance imaging (MRI) scan, preoperative and adjuvant systemic treatment, and immediate breast reconstruction. For 70%, 13%, 97% and 13% of patients, respectively, all necessary data were available. The two most frequent underreported data-items were "clinical M-stage" (87%) and "assessable mammography" (28%). Treatment alternatives were reported by MDTs in 32% of patients regarding primary treatment and in 28% regarding breast reconstruction. Conclusion Both the availability of data in patient records essential for guideline-based recommendations and the reporting of possible treatment alternatives of the investigated CDTs were low. To meet EUSOMA's requirements, information that is supposed to be implicitly known must be explicated by MDTs. Moreover, MDTs have to adhere to clear definitions of data-items in their reporting. Keywords Guidelines • Clinical decision trees • Decision support • Breast cancer • Multidisciplinary team Abbreviations AST Adjuvant systemic treatment CDT Clinical decision tree EUSOMA European Society of Breast Cancer Specialists IBR Immediate breast reconstruction MDT Multidisciplinary team MRI Magnetic resonance imaging PST Preoperative systemic treatment TNM Tumor (T), nodes (N) and metastases (M) Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Using guideline-based clinical decision support in oncological multidisciplinary team meetings: A prospective, multicenter concordance study

“…An unconditional recommendation from a CDT depends on availability of complete data. In this study, data availability per case was higher than previously reported [ 11 , 12 , 18 ]. The systematic application of a CDT uncovers the amount of missing data required for guideline-based decision-making and thereby may stimulate a more complete reporting of necessary data.…”

“…To date, CDTs were evaluated on validity for usage in MDTs retrospectively by Hendriks et al. [ 11 ] for breast cancer and by Keikes et al. [ 12 ] for colorectal cancer.…”

As Novas Faces Da Saúde: Tecnologia E Multidisciplinaridade No Contexto Atual

“…Portanto, a formação de uma equipe multidisciplinar oferece muitas vantagens, como um diagnóstico mais preciso, menor tempo do diagnóstico ao tratamento, maior probabilidade de administrar todos os tratamentos, melhor comunicação de todos os membros e maior suporte para o manejo do paciente, mas a transferência parcial de seus trabalhos para o meio virtual pode causar um impacto em suas demandas, já que a implementação do mesmo ocorreu em caráter emergencial. (HENDRIKS et al, 2020).…”

Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review

“…A Dutch clinical decision support system incorporates the recommendations of the European Society of BC Specialists (EUSOMA), each patient has to be fully informed about each step in the diagnostic and therapeutic pathway and must be given adequate time to consider the alternatives and make an informed decision. 26 , 27 …”

“…each patient has to be fully informed about each step in the diagnostic and therapeutic pathway and must be given adequate time to consider the alternatives and make an informed decision. 26 , 27 …”