Looking through the eyes of the multidisciplinary team: the design and clinical evaluation of a decision support system for lung cancer care.

Autor:	Pluyter JR; Philips Experience Design, High Tech Campus 33, Eindhoven, The Netherlands., Jacobs I; Department of Oncology Solutions, Philips Research Europe, High Tech Campus 34, Eindhoven, The Netherlands., Langereis S; Department of Oncology Solutions, Philips Research Europe, High Tech Campus 34, Eindhoven, The Netherlands., Cobben D; Department of Radiotherapy Related Research, University of Manchester-The Christie National Health Trust, Manchester, UK., Williams S; Philips Experience Design, High Tech Campus 33, Eindhoven, The Netherlands., Curfs J; Department of Pulmonary Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., van den Borne B; Department of Pulmonary Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Jazyk:	angličtina
Zdroj:	Translational lung cancer research [Transl Lung Cancer Res] 2020 Aug; Vol. 9 (4), pp. 1422-1432.
DOI:	10.21037/tlcr-19-441
Abstrakt:	Background: Decision-making in lung cancer is complex due to a rapidly increasing amount of diagnostic data and treatment options. The need for timely and accurate diagnosis and delivery of care demands high-quality multidisciplinary team (MDT) collaboration and coordination. Clinical decision support systems (CDSSs) can potentially support MDTs in constructing a shared mental model of a patient case. This enables the team to assess the strength and completeness of collected diagnostic data, stratification for the right personalized therapy driven by clinical stage and other treatment-influencing factors, and adapt care management strategies when needed. Current CDSSs often have a suboptimal fit into the decision-making workflow, which hampers their impact in clinical practice. Methods: A CDSS for multidisciplinary decision-making in lung cancer was designed to support the abovementioned goals through presentation of relevant clinical data in line with existing mental model structures of the MDT members. The CDSS was tested in a simulated multidisciplinary tumor board meeting for primary diagnosis and treatment selection, based on de-identified primary lung cancer cases (n=8). Decision course analysis, eye-tracking data and questionnaires were used to assess the impact of the CDSS on constructing shared mental models to improve the decision-making process and outcome. Results: The CDSS supported the team in their self-correcting capacity for accurate diagnosis and TNM classification. It enabled cross-validation of diagnostic findings, surfaced discordance between diagnostic tests and facilitated cancer staging according the diagnostic evidence, as well as spotting contra-indications for personalized treatment selection. Conclusions: This study shows the potential of CDSS on clinical decision making, when these systems are properly designed in line with clinical thinking. The presented setup enables assessment of the impact of CDSS design on clinical decision making and optimization of CDSSs to maximize their effect on decision quality and confidence. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-19-441). Dr. JRP, Dr. SL, and Dr. DC have a patent Multidisciplinary Decision Support WO/2018/215603 pending. The other authors have no conflicts of interest to declare. (2020 Translational Lung Cancer Research. All rights reserved.)
Databáze:	MEDLINE
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