Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures?

Abstract

Purpose of reviewDespite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine.Recent findingsSome studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability.SummaryIn principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.

Automated Monitoring of Adherence to Evidenced-Based Clinical Guideline Recommendations: Design and Implementation Study

“…Although we have not yet conducted a formal evaluation of the system's impact on clinical practice and patient outcomes, we believe that the system has the potential to improve patient care by assisting health care professionals in making informed decisions based on the latest evidence-based guideline recommendations. Studies have consistently shown that the implementation of guideline-based CDS systems can potentially improve the quality of care [57], increase guideline adherence [58,59], and positively impact the care process [60,61]. However, it should be noted that larger trials are needed to confirm these findings and that it is crucial to improve the interoperability of CISs to establish a widespread use of CDS systems, such as those developed by us [59].…”

“…Studies have consistently shown that the implementation of guideline-based CDS systems can potentially improve the quality of care [57], increase guideline adherence [58,59], and positively impact the care process [60,61]. However, it should be noted that larger trials are needed to confirm these findings and that it is crucial to improve the interoperability of CISs to establish a widespread use of CDS systems, such as those developed by us [59]. The system developed in this study could help overcome some of the challenges commonly encountered in the implementation of guideline-based CDS systems.…”

Clinical Decision Support Systems Applied to the Management of Breast Cancer Patients: A Scoping Review

“…However, although breast cancer is one of the cancers with the best prognosis, we still need accurate, adapted and cutting-edge CDSSs to assist the decision-making process. Numerous reviews of the literature on the CDSSs used in the cancer domain have been published [2][3][4], among which some are specifically focused on breast cancer [5]. Breast cancer CDSSs may be applied to patient screening, diagnostic, therapeutic, or follow-up management.…”