Use of clinical decision support tools in the management of patients with colorectal cancer

Abstract

Introduction: There is a drive to individualise cancer care. Computerized clinical decision support (CDS) tools providing patient-specific advice on colorectal cancer (CRC) management are available and include Adjuvant! (Predicts recurrence risk and treatment benefit), the ACPGBI peri-operative mortality model, and the St Mark’s lymph node positivity model. Their uptake and influence in NZ has not previously been reported. Objectives: To investigate current utilisation and clinician’s predictions of change in their impact over the next 10 years. Methods: Online survey of clinicians who manage CRC in NZ (n = 89). Results: Adjuvant! For colon cancer is the most widely known CDS tool for the management of CRC; it is currently used by 21/89 clinicians. Adjuvant! Users consulted this tool five times (range 1–90) over 6 months for 90% (range 50– 90%) of their eligible patients. A third of users report that Adjuvant! Effects their clinical decisions; 43% that it improves patients’ outcomes. Use of these tools is most commonly limited by their relevance to the respondent’s clinical practice, lack of Internet access, and time pressure. Over 75% of respondents who treat CRC predict that the impact of CDS tools for patients with cancer will substantially increase over the next 10 years. Conclusions: Current practice varies widely; some clinicians consult CDS tools during the care of every patient with CRC and alter their clinical decisions based on its advice, while others are not aware of them. Nevertheless the majority of respondents predict that the impact of CDS tools will increase over the next decade. Recent systematic reviews of CDS tools (1,2) highlight the lack of high quality prospective trials assessing their effect on practitioner performance and patient outcomes. It is vital that these tools are adequately validated for our population, and their ability to positively influence patient outcome is assessed. References: 1. Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA Mar 9 2005;293(10):1223. 2. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ Apr 2; 20.