Patient-centred consultation of clinical practice guidelines: OncoDoc, a decision support system for the management of breast cancer patients

Beyond considerations of cost-effectiveness, clinical practice guidelines ( CPG) can reduce practice variations and thus improve the quality of fare. H owever, despite the proliferation of implemented CPG and their wide diffusi on thanks to Internet-based technologies, physicians compliance with formal standards is weak, Developed according to a document-based paradigm, OncoD oc proposes an original framework for implementing CPG. Domain knowledge ha s been encoded as a decision tree whose branches are both exclusive and exh austive. This generic knowledge is operationalized at the point of care by the interactive building, through hypertextual navigation, of a patient-bas ed clinical contest leading to specific therapeutic recommendations. OncoDo c has first been applied to the management of breast cancer patients and de monstrated within a full-scale experimentation in a clinical setting a comp liance of 80 per cent.