Personalization and Patient Involvement in Decision Support Systems: Current Trends

Abstract

Objectives: This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care.

Methods: We considered papers published on scientific journals, by querying PubMed and Web of ScienceTM. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support.

Results: We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness.

Conclusions: Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large.

Keywords: Decision support systems; clinical; decision aids; decision making; patient empowerment; patient-centered care; shared.

Fig. 1

Papers including “shared decision making” (SDM) in their title, published in the last 15 years (source: PubMed).

Fig. 2

Publication trend of CPOE-related papers in the last 15 years (search by title, source PubMed)

Fig. 3

Review steps and results for DSSs and CPOEs.

Fig. 4

Summary description of DSS (top) and CPOE (bottom) papers according to the identified dimensions