Using computerised decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance

Abstract

Objectives: The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs.

Design: Audit study and a questionnaire survey.

Setting: Breast multidisciplinary unit in a large secondary care teaching hospital.

Participants: All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey.

Outcome measures: The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials.

Results: MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered.

Conclusions: Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient outcomes. The decision support technology used in MATE is generic and if found useful can be applied across medicine.

Conflict of interest statement

Competing interest: VP, DA, JF and MK have following specified non-financial interests that may be relevant to the submitted work. UCL (B) (a subsidiary of University College London) and ISIS innovation (a subsidiary of the University of Oxford) are actively seeking to commercialise aspects of this project through a spin-out company.

Figures

Figure 1

MATE (Multidisciplinary meeting Assistant and Treatment sElector) in use at Royal Free breast multidisciplinary team meeting.

Figure 2

Composite screenshot showing the user interface and some of the functionalities of MATE (Multidisciplinary meeting Assistant and Treatment sElector). Upper left: the summary screen for the patient; upper right: one of the many prognostication tools available; lower left: decision panel where system recommendations and eligible clinical trials are highlighted in blue; lower right: the evidential justification for each recommended option.