Clinical decision trees support systematic evaluation of multidisciplinary team recommendations

Area of Science:

• Oncology
• Medical Informatics
• Clinical Guidelines

Background:

• European Society of Medical Oncology (EUSOMA) guidelines emphasize comprehensive patient information.
• Guideline-based clinical decision trees (CDTs) can support patient communication in diagnostic and therapeutic pathways.
• The Dutch breast cancer guideline has been adapted into CDTs for clinical use.

Purpose of the Study:

• To evaluate the availability of patient data required for CDTs at the time of multidisciplinary team (MDT) meetings.
• To assess the extent to which treatment alternatives are reported in clinical practice.
• To determine adherence to EUSOMA recommendations regarding patient information in breast cancer care.

Main Methods:

• Retrospective analysis of 394 non-metastatic breast cancer patient records (2012-2015).
• Evaluation of four pivotal CDTs: MRI indication, preoperative systemic treatment, adjuvant systemic treatment, and immediate breast reconstruction.
• Two researchers assessed data availability and reporting of treatment alternatives in MDT meetings.

Main Results:

• Data availability for CDTs varied significantly: 70% for MRI indication, 13% for preoperative treatment, 97% for adjuvant treatment, and 13% for breast reconstruction.
• Key underreported data items included clinical M-stage (87%) and assessable mammography (28%).
• MDTs reported treatment alternatives in only 32% of primary treatment cases and 28% of breast reconstruction cases.

Conclusions:

• There is a low availability of essential patient data for guideline-based recommendations and underreporting of treatment alternatives within CDTs.
• MDTs need to explicate implicitly known information and adhere to clear data-item definitions to meet EUSOMA requirements.
• Improving data completeness and reporting of treatment options is crucial for enhancing patient information in breast cancer care.