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Effects of breast cancer guideline support using Oncoguide on the care plan determined in multidisciplinary team meetings : a retrospective analysis

Heijden, S.E. van der (2018) Effects of breast cancer guideline support using Oncoguide on the care plan determined in multidisciplinary team meetings : a retrospective analysis.

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Abstract:Introduction: The breast cancer care guideline is an extensive document which is not easy to apply in clinical practice, for example during multidisciplinary team (MDT) meetings in hospitals. Oncoguide provides an easily interpretable application presenting breast cancer guideline recommendations in clinical decision trees (CDTs). The aim of this study was fourfold: (1) to determine whether the procedure or treatment was recommended for a patient according to the guideline and was also discussed during MDTs and with the patient (as documented in MDT reports and in the electronic health record [EHR]), (2) and when it was not discussed with the patient, why not. Furthermore, (3) to determine what the treatment recommendation for the patient was provided through Oncoguide compared to the recommendation of the guideline and (4) whether there was any data missing in order to derive this treatment recommendation via the CDTs. Methods: For this retrospective study female patients with primary breast cancer of 18 years and older diagnosed and treated at the Northwest Clinics in the Netherlands between 14 February 2012 and 13 February 2015 were selected from the Netherlands Cancer Registry. The data was retrieved from the EHR and collected in a database focussing on the following four procedure/treatment recommendations: MRI scan (MRI), neoadjuvant systemic treatment (NST), adjuvant systemic treatment (AST) and direct breast reconstruction (DBR). These four treatment recommendations were analysed for every included patient focusing on the four points of interest mentioned above. Results: In total, 395 patients were selected of which 24 did not have surgery and thus were not eligible for AST or DBR. In 65 cases a diagnostic procedure or treatment was recommended according to the guideline but not performed/discussed with the patient (MRI: n = 12, NST: n = 8, AST: n = 3 and DBR: n = 42). Of these 65 cases, the motivation for deviating from the guideline was documented in 7 cases (MRI: n = 1, NST: n = 3, AST: n = 1 and DBR: n = 1). Treatment recommendations provided through Oncoguide were presented differently compared to the guideline with MRI in 71 cases; with NST in 146 cases and with AST in 13 cases (n = 220 recommendations in total). The different presentation of the treatment recommendations provided through Oncoguide could be seen in presenting multiple options (100.0% for neoadjuvant and adjuvant), indicating missing data to fill the CDT (56.3%, n = 40 for MRI) or presenting the recommendation elsewhere (43.7%, n = 31 for MRI). Conclusion: Applying Oncoguide retrospectively shows effects on treatment decisions as reported by MDTs. These effects can be found in presenting multiple potential treatment options as well as in encouraging active documentation of motivations when deviating from the guideline. This could potentially lead to a decrease in unwanted practice variation and an increase in shared decision making by focussing more on patient’s considerations and wishes. Oncoguide also shows effects on treatment decisions by detecting missing patient data, preventing unnecessarily discussed patients during MDTs which is an advantage, since care professional’s time is precious. Discussion: This study was limited by its retrospective lay out. The analysis was based on data as documented between 2013 and 2015 in the EHR and it can be assumed that information (such as motivation for deviating from the guideline) was present during MDT meetings but not documented at that moment.
Item Type:Essay (Master)
Noordwest Ziekenhuisgroep, Alkmaar, Nederland
Integraal Kankercentrum Nederland, Utrecht, Nederland
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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