Safety and Decision Support in Oncology

P. Hammond; A. L. Harris; S. K. Das; J. C. Wyatt

doi:10.1055/s-0038-1635046

Methods of Information in Medicine, Table of Contents

Methods Inf Med 1994; 33(04): 371-381
DOI: 10.1055/s-0038-1635046

Original Article

Schattauer GmbH

Safety and Decision Support in Oncology

P. Hammond

¹Advanced Computation Laboratory, Imperial Cancer Research Fund, London

²School of Dentistry, The University of Birmingham, Birmingham

,

A. L. Harris

³University of Oxford, ICRF Clinical Oncology Unit, Churchill Hospital, Oxford

,

S. K. Das

⁴Department of Computer Science, Queen Mary and Westfield College, London

,

J. C. Wyatt

⁵Biomedical Informatics Unit, Imperial Cancer Research Fund, London, UK

› Author Affiliations

Abstract

Abstract:

The management of patients with cancer involves the administration of complex treatment protocols with frequent monitoring of the effects of treatment on the malignant disease as well as on the general health of the patient. The number and wide variety of protocols used in treatment trials, and the amount of clinical data generated suggest the need for computer-based support. The toxicity of many of the treatments used and the severity of the disease itself underline the safety-critical nature of all decisions made by oncologists, the physicians and surgeons who treat cancer patients. This paper presents recent work on the analysis of safety issues arising from the design and implementation of a protoype decision-support system for oncologists. It illustrates the benefits of combining both informal and formal approaches to the analysis and representation of safety, firmly based on a thorough and detailed study of the domain in cooperation with oncologists, pharmacists and medical informaticians.

Keywords

Safety - Decision Support - Oncology - Logic

Full Text

References

REFERENCES
1 Fox J. Engineering safety into expert systems. In: Redmill F, Anderson T. eds. Safety-Critical Systems. London: Chapman and Hall; 1993
2 Ayel M, Laurent J-P. eds. Validation, Verification and Test of Knowledge-Based Systems. Chichester: Wiley; 1991
3 Hyman WA, Johnston WA, Spar S. Legal liability and system safety applied to expert systems. Pergamon Press: Computers and Engineering 1989; 16: 355-62.
4 Miller PL, Sittig DF. The evaluation of clinical decision support systems: what is necessary versus what is interesting. Med Inform 1990; 15: 185-90.
5 Wyatt JC, Spiegelhalter D. Evaluating medical expert systems: what to test and how?. Med Inform 1990; 15: 205-17.
6 IEC. Functional safety of electrical/electronic/programmable electronic systems: Generic Aspects. Part 1: General requirements. Draft of Working Group 10 of SC 65A. 1991
7 Bell R. IEC Draft international standard on functional safety: current position. High Integrity Systems 1994; 01: 73-7.
8 DeMarco T. Structured Analysis and System Specification. Englewood Cliffs: Yourdan Press y1979.;
9 HSE. Programmable Electronic Systems (PES) in Safety Related Applications. Health and Safety Executive, UK; 1987
10 Mead GM, Kaye SB. A Medical Research Council/EORTC collaborative randomised trial of BEP/EP vs BOP/VIP-B with or without G-CSF in the management of poor prognosis metastatic and extragonadal teratoma. MRC Cancer Trials Office, 1 Brook-lands Ave, Cambridge CB2 2BB, 1991
11 Shortliffe EH, Scott AC, Bischoff MB, Campbell AB, Van Melle W, Jacobs CD. ONCOCIN: An expert system for oncology protocol management. In: Proceedings of IJCAI’81. 01 876-81.
12 Lane CD, Walton JD, Shortliffe EH. Graphical access to expert systems:: II. Design of an interface for physicians. Meth Inform Med 1986; 25: 143-50.
13 Kent D, Shortliffe EH, Carlson R, Bischoff M, Jacobs C. Improvements in data collection through physician use of a computer-based chemotherapy treatment consultant. J Clin Oncol 1985; 03: 1409-17.
14 Litzelman DK, Dittus RS, Miller ME, Tier-ney WM. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gent Intern Med 1993; 08: 311-7.
15 THERAC. Software bugs, a matter of life and liability. Datamation. May 15th, 1987
16 Theriault RL, Stallings CB, Buzdar AU. Pregnancy and breast-cancer – clinical and legal issues. Am J Clin Oncol 1992; 15: 535-9.
17 Reintgen D, Cox C, Greenberg H. et al. The medical legal implications of following mam-mographic breast masses. The American Surgeon 1993; 59: 99-105.
18 BO03 A randomised trial of two chemotherapy regimens in the treatment of operable osteosarcoma. MRC Cancer Trials Office, 1 Brooklands Ave, Cambridge CB2 2BB, 1986
19 Hammond P. OaSiS: a decision-support system for the protocol-based treatment of cancer. In: Procedings of 2nd International Conference on the Practical Application of PROLOG. April 1994. London: 253-70.
20 Musen MA, Tu SW, Shahar Y. A problem-solving model for protocol-based care: frome e-ONCOCIN to EON. Knowledge Systems Laboratroy Memo KSL-91-61, Medical Computer Science, Stanford University, Stanford, California 94305-5479. (Also in Proceedings of MEDINFO ‘92 Geneva, Switzerland, September 1992).
21 British National Formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain, Tavistock Square, London WC1H 9JP, UK. 1992
22 ABPI Data Sheet Compendium 1993-94. Da-tapharm Publications Ltd, 12 Whitehall. London SW1A2DY: 1993
23 Deliyanni A, Kowalski RA. Logic and semantic networks. Comm ACM 1979; 22: 184-92.
24 Hammond P. Oncology protocol knowledge elicitation and OaSiS prototype review, RED/ICRF/WP/810.3/1. Advanced Computation Laboratory, ICRF, PO Box 123 Lincoln’s Inn Fields, LONDON; WC2A 2PX, 1993..
25 Seymour MT, Slevin ML. A randomised trial of 5FU and leucovorin versus 5FU, leuco-vorin and interferon-α2a for advanced colorectal adenocarcinoma. MRC Cancer Trials Office, 1 Brooklands Ave, Cambridge CB2 2BB, 1991
26 Kowalski RA. Logic for Problem Solving. Amsterdam: Elsevier; 1973
27 Grant J, Minker J. Integrity constraints in knowledge-based systems. In: Adeli H. ed. Knowledge Engineering Applications. Vol HI. New York: McGraw-Hill; 1990: 1-25.
28 Hammond P, Davenport JC, Fitzpatrick FJ. Logic based integrity constraints and the design of dental prostheses. Artif Intell Med 1993; 05: 431-46.
29 Das SK, Hammond P. An interval-based modal temporal logic. In: Bramer MA, Macintosh AL. eds. Research and Development in Expert Systems X. BHR Group Ltd and BCS SGES; 1993: 131-41.
30 Das SK, Fox J. A logic for reasoning about safety in decision support systems. In: Second European Conference on Symbolic and Quantitative Approaches to Reasoning and Uncertainty. November, 1993 Granada, Spain..
31 Das SK, Hammond P. A Logic of Action, Obligation and Time. Dept of Computer Science, QMW, Mile End Road, London, 1994
32 Wyatt JC, Altaian DG, Heathfield HA, Pan-tin FA. Development of Design-a-Trial, a knowledge-based critiquing system for authors of clinical trial protocols. Comp. Methods Programs Biomed 1944; 43: 283-91.