Abstract
Despite multidisciplinary staff meetings (MSMs) and the publication of clinical practice guidelines (CPGs), actual cancer management may still vary from guideline-based recommendations. Motivations that support non-compliance with guidelines are not well characterized. From the model of evidence-based medicine practice elaborated by Haynes et al. (2002), we propose a categorization of the reasons that lead to non-CPG-compliant decisions. Theses reasons are classified as particular case, patient choice, MSM choice, and evolution of practices. OncoDoc2 is a clinical decision support system developed to deliver the “CancerEst” local guideline recommendations on breast cancer management used at the Tenon hospital, Paris, France. After a before/after intervention study in 2005– 2006, OncoDoc2 has been routinely used at Tenon, during weekly MSMs in the sake of quality management. After nearly 3 years, a high CPG adherence rate has been maintained over 90%. An evaluation of non-compliant decisions has been performed according to the proposed categorization illustrating that a 100% adherence rate would be neither reachable, nor desirable.
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Bouaud, J. et al. (2011). Catégorisation des décisions hors «référentiel de pratiques cliniques»: Une application à la prise en charge des cancers du sein avec le système OncoDoc2. In: Staccini, P.M., Harmel, A., Darmoni, S.J., Gouider, R. (eds) Systèmes d’information pour l’amélioration de la qualité en santé. Informatique et Santé, vol 1. Springer, Paris. https://doi.org/10.1007/978-2-8178-0285-5_20
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DOI: https://doi.org/10.1007/978-2-8178-0285-5_20
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