Motivation
In late 2003 over 50 leading oncologists, clinical scientists and others came together to develop a "vision" of priorities for cancer research and clinical practice (Sikora, 2004). During Cancer 2025 it was observed that although there are perhaps around 1000 compounds currently in development as potential anticancer agents, few in the therapeutics field expect many of these to be "blockbusters". In fact, it is widely thought that even in those cases where initial trials have been promising the actual benefits of new compounds may be quite limited. It was also suggested that if we are looking for a "5% or 10%, or even greater improvement in outcome" then computers could offer a highly promising way forward.
A series of influential reports from the US Institute of Medicine (Kohn et al, 1999) focused attention on human factors in achieving consistently safe decision-making in difficult conditions. Quality and safety are now major issues with many governments and agencies pursuing policies to improve care at both individual and organizational levels. In the UK the difficulties for hard-pressed clinicians to deliver consistently high quality, safe care are also increasingly well documented. In cancer services, for example, the joint report by the Commission for Healthcare Improvement and Audit Commission on cancer care identifies a wide range of challenges to the consistent delivery of effective detection, diagnosis and treatment.
General research in the field of decision support systems, as well as our own results, give strong evidence that major improvements in many aspects of clinical decision-making are achievable.