An expert at your fingertips. Development of a computerised clinical guidance programme to help with the prophylactic oophorectomy decision

Objective

To develop a computerised Clinical Guidance Programme (CGP) to assist women and clinicians in the prophylactic oophorectomy (PO) decision and to undertake a preliminary evaluation. PO is undertaken in about 50% of abdominal hysterectomies as a prophylactic measure against ovarian cancer, but it can have a number of longer term health consequences that may be difficult to take into account during the clinical decision.

Methods

We have developed a CGP, based on a series of Markov models for each of the main health outcomes involved in the PO decision—ovarian cancer, breast cancer, coronary heart disease and major fracture due to osteoporosis. The results, using data drawn from a systematic literature review, are adjusted to reflect womens' own individual risk factors, health state valuations, attitudes to risk and predictions as to their likely intake of HRT. In conjunction with a facilitator, women record their major risk factors including smoking, hypertension and family history of breast and ovarian cancer. They complete the EuroQol 5D, and undertake a number of health state valuations using a time trade off method. Women may opt out of any of these tasks, in which case the CGP is run using average values from population surveys. Full access to the underlying data, calculations and sources of evidence is provided.

Results

Preliminary evaluation shows that the CGP administered by a researcher gives meaningful results and takes about 30 minutes to complete. Initial consultant reaction is favourable but almost all clinicians approached have been reluctant to use the CGP themselves. Using averaged values with “dummy patients” the CGP produces patient specific guidance in line with current published guidelines and current clinical practice. The CGP took approximately two person years to develop, but the model structure is generic and may be modified easily to numerous decisions.

Conclusions

This work indicates that development of a …