Creation of clinical algorithms for decision-making in oncology: an example with dose prescription in radiation oncology

BMC Medical Informatics and Decision Making

Thomas Iseli¹  Fabio Dennstädt¹  Cédric Panje²  Paul Martin Putora²  Theresa Treffers³ 

[1] Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland;Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland;Department of Radiation Oncology, University of Berne, Berne, Switzerland;Seeburg Castle University, Seekirchen am Wallersee, Austria;TUM School of Management, Technical University of Munich, Munich, Germany;

关键词: Decision-making;    Clinical algorithm;    Decision strategy;    Radiation oncology;    Dose prescription;    Bone metastases;   

DOI  :  10.1186/s12911-021-01568-w

来源: Springer

【 摘 要 】

In oncology, decision-making in individual situations is often very complex. To deal with such complexity, people tend to reduce it by relying on their initial intuition. The downside of this intuitive, subjective way of decision-making is that it is prone to cognitive and emotional biases such as overestimating the quality of its judgements or being influenced by one’s current mood. Hence, clinical predictions based on intuition often turn out to be wrong and to be outperformed by statistical predictions. Structuring and objectivizing oncological decision-making may thus overcome some of these issues and have advantages such as avoidance of unwarranted clinical practice variance or error-prevention. Even for uncertain situations with limited medical evidence available or controversies about the best treatment option, structured decision-making approaches like clinical algorithms could outperform intuitive decision-making. However, the idea of such algorithms is not to prescribe the clinician which decision to make nor to abolish medical judgement, but to support physicians in making decisions in a systematic and structured manner. An example for a use-case scenario where such an approach may be feasible is the selection of treatment dose in radiation oncology. In this paper, we will describe how a clinical algorithm for selection of a fractionation scheme for palliative irradiation of bone metastases can be created. We explain which steps in the creation process of a clinical algorithm for supporting decision-making need to be  performed and which challenges and limitations have to be considered.

【 授权许可】

CC BY