Last reviewed: 13 July 2020
Last reviewed: 13 July 2020
Some CDS tools are underpinned by algorithms which calculate the risk of a patient having an undiagnosed cancer. Algorithms can be based on symptoms and tests alone or consider other factors such as patient age, gender and risk factors. Computer-based algorithms are often integrated into a GPs usual patient management system, meaning they are accessible during consultations.
There are several studies which have evaluated the use and impact of CDS tools which are based on algorithms to calculate a patient’s risk of having an undiagnosed cancer. For example, in an evaluation of the 7PCL for melanoma, GPs found the tool useful and easy to use, particularly for ‘borderline decision making’ and to facilitate discussion with patients
. However, authors noted that there is variation in the implementation and use of the tool by GPs.A key challenge to the use of CDS tools is the effective implementation into practice. A 2017 survey disseminated to GPs across the UK assessed the availability and use of QCancer® and Risk Assessment Tools (RATs) . Less than 20% of practices had electronic CDS tools available and more than a third of GPs were unaware of the tools. To better understand the use and impact of CDS tools, more robust evaluation is needed.General functionalities that may be included within an electronic CDS tool:
An automated prompt that draws on the information in a patient’s medical record and sends an alert if the calculated score exceeds a set threshold
A symptom checker that provides a cancer risk score based on symptoms entered onto the system
A risk stratification list draws on medical data within patient records and produces a list of all patients within that practice exceeding a set threshold of risk
Clinical Decision Support (CDS) tools are designed to support health professionals to recognise potential cancer signs and symptoms and manage patients appropriately. CDS tools can be broadly categorised into 2 different groups:
Computer-based algorithm tools
Electronic and printed visualisations of guidelines
CDS tools do not replace clinical judgement. Instead they provide further guidance to inform patient management decisions. This may be to refer, to safety net, or it may support the decision on which pathway is most appropriate.
At the University of Exeter, Professor Willie Hamilton is leading the Electronic Risk Assessment for Cancer (ERICA) trial to evaluate 6 newly developed electronic RATs.
Price, S., et al., Availability and use of cancer decision-support tools: a cross-sectional survey of UK primary care. Br J Gen Pract, 2019.
Pannebakker, M.M., et al., Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation. BJGP open, 2019. 3(1): p. bjgpopen18X101635-bjgpopen18X101635.
Accelerate, Coordinate, Evaluate (ACE) Programme. Using Cancer Decision Support Tools to support the early diagnosis of cancer(PDF). 2017.
