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. 2020 Sep;183(2):355-363.
doi: 10.1007/s10549-020-05769-1. Epub 2020 Jul 6.

Clinical decision trees support systematic evaluation of multidisciplinary team recommendations

Mathijs P Hendriks  1   2   3 , Xander A A M Verbeek  4 , Jeannette G van Manen  5 , Sannah E van der Heijden  5 , Shirley H L Go  6 , Gea A Gooiker  7 , Thijs van Vegchel  4 , Sabine Siesling  4   5 , Agnes Jager  8
Affiliations

Clinical decision trees support systematic evaluation of multidisciplinary team recommendations

Mathijs P Hendriks et al. Breast Cancer Res Treat. 2020 Sep.

Abstract

Purpose: EUSOMA's recommendation that "each patient has to be fully informed about each step in the diagnostic and therapeutic pathway" could be supported by guideline-based clinical decision trees (CDTs). The Dutch breast cancer guideline has been modeled into CDTs ( www.oncoguide.nl ). Prerequisites for adequate CDT usage are availability of necessary patient data at the time of decision-making and to consider all possible treatment alternatives provided in the CDT.

Methods: This retrospective single-center study evaluated 394 randomly selected female patients with non-metastatic breast cancer between 2012 and 2015. Four pivotal CDTs were selected. Two researchers analyzed patient records to determine to which degree patient data required per CDT were available at the time of multidisciplinary team (MDT) meeting and how often multiple alternatives were actually reported.

Results: The four selected CDTs were indication for magnetic resonance imaging (MRI) scan, preoperative and adjuvant systemic treatment, and immediate breast reconstruction. For 70%, 13%, 97% and 13% of patients, respectively, all necessary data were available. The two most frequent underreported data-items were "clinical M-stage" (87%) and "assessable mammography" (28%). Treatment alternatives were reported by MDTs in 32% of patients regarding primary treatment and in 28% regarding breast reconstruction.

Conclusion: Both the availability of data in patient records essential for guideline-based recommendations and the reporting of possible treatment alternatives of the investigated CDTs were low. To meet EUSOMA's requirements, information that is supposed to be implicitly known must be explicated by MDTs. Moreover, MDTs have to adhere to clear definitions of data-items in their reporting.

Keywords: Breast cancer; Clinical decision trees; Decision support; Guidelines; Multidisciplinary team.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Example of the clinical decision tree (CDT) of “pre-operative MRI scan” in Oncoguide. MRI is indicated in case of (i) breast-conserving surgery, unless tumor size is already assessed; (ii) discrepancy between tumor size assessed by clinical examination, mammography and/or ultrasound; (iii) lobular carcinoma unless unifocal mass on well assessable mammography. **PST = preoperative systemic treatment
Fig. 2
Fig. 2
Example of the clinical decision tree regarding first treatment. Note that some “leaves” (i.e., the rectangles at the bottom of the CDT) result in a guideline-based recommendation with more than one alternative
See this image and copyright information in PMC

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