Enhancing clinical practice guideline compliance by involving physicians in the decision process

Abstract

Despite the proliferation of implemented clinical practice guidelines (CPGs) as decision support systems, there is still little evidence of changes in physicians behavior. The reasons usually evoked to explain the low physicians compliance consider the incompleteness of guidelines knowledge, the impreciseness of the terms used and the physicians psychological reluctance. Another reason comes from the original verbal design of CPGs as well as the impossibility to enumerate all the contexts in which a guideline applies, which avoid the automatised control of all CPGs interpretations and therefore the design of robust formal models. The OncoDoc approach proposes a decision support frame- work for implementing guidelines where the context-based interpretation is controlled by clinicians. The first application deals with breast cancer therapy. Experimented in real size at the point of care, the sys- tem demonstrated significantly high scores of theoretical agreement with CPGs recommendations and compliance.