Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands.
Department of Medical Oncology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
BMC Med Inform Decis Mak. 2018 Dec 14;18(1):132. doi: 10.1186/s12911-018-0712-9.
Decision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Decision support systems (DSS), e.g., prognostic calculators, can aid oncologists' decision-making. DSS that contain features tailored to the needs of oncologists are more likely to be implemented in clinical practice. Therefore, our aim is to inventory colorectal cancer specialists' unmet decision support needs.
We asked oncologists from the Dutch colorectal cancer group (DCCG), to participate in an online inventory questionnaire on their unmet decision support needs. To get more in-depth insight in required features of the DSS they need, we also conducted semi-structured telephone interviews.
Forty-one oncologists started the inventory questionnaire, and 27 of them completed all items. Of all respondents, 18 were surgeons (44%), 22 were medical oncologists (54%), and 28 (68%) had more than 10 years of experience treating mCRC. In both the inventory questionnaire and interviews, respondents expressed a need for an overarching DSS incorporating multiple treatment options, and presenting both the treatment benefits and harms. Respondents found it relevant for other outcomes, such as cost-effectiveness of treatment or quality of life, to be incorporated in DSS. There was also a wish for DSS incorporating an up-to-date "personalized" overview of the ongoing trials for which a specific patient is eligible.
Experienced oncologists indicate that their treatment advice is currently almost solely based on the available clinical guidelines. They experience a lack of good quality DSS to help them personalize their treatment advice. New tools integrating multiple treatment options and providing a broad range of clinically relevant outcomes are urgently needed to stimulate and safeguard more personalized treatment decision-making.
转移性结直肠癌（mCRC）的姑息治疗决策包含许多不同的治疗相关决策，通常没有最佳的治疗选择。决策支持系统（DSS），例如预后计算器，可以帮助肿瘤学家做出决策。包含针对肿瘤学家需求定制功能的 DSS 更有可能在临床实践中实施。因此，我们的目标是盘点结直肠癌专家的未满足的决策支持需求。
我们邀请荷兰结直肠癌小组（DCCG）的肿瘤学家参与在线库存问卷，了解他们未满足的决策支持需求。为了更深入地了解他们需要的 DSS 的功能，我们还进行了半结构化电话访谈。
41 名肿瘤学家开始填写库存问卷，其中 27 名完成了所有项目。在所有受访者中，18 人是外科医生（44%），22 人是肿瘤内科医生（54%），28 人（68%）有 10 年以上治疗 mCRC 的经验。在库存问卷和访谈中，受访者都表示需要一个包含多种治疗方案并同时呈现治疗益处和危害的综合 DSS。受访者认为其他结果（如治疗的成本效益或生活质量）纳入 DSS 也很重要。他们还希望 DSS 能纳入一个最新的“个性化”正在进行的试验概述，其中包含特定患者有资格参加的试验。
经验丰富的肿瘤学家表示，他们目前的治疗建议几乎完全基于现有的临床指南。他们缺乏帮助他们个性化治疗建议的高质量 DSS。需要新的工具来整合多种治疗方案，并提供广泛的临床相关结果，以刺激和保障更个性化的治疗决策。
