Abstract
Most guidelines developed for cancers screening and for cardiovascular risk management use rules to estimate familial risk. These rules are complex, difficult to memorize, and need to collect a complete pedigree. This paper describes a generic computerized method to estimate familial risks and its implementation in an internet-based application. The program is based on 3 generic models: a model of the family; a model of familial risk; a display model for the pedigree. The model of family allows to represent each member of the family and to construct and display a family tree. The model of familial risk is generic and allows easy update of the program with new diseases or new rules. It was possible to implement guidelines dealing with breast and colorectal cancer and cardiovascular diseases prevention. First evaluation with general practitioners showed that the program was usable. Impact on quality of familial risk estimate should be more documented.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Balas E. A., Austin S. M., Mitchell J. A., Ewigman B. G., Bopp K. D., Brown G. D. The clinical value of computerized information services. A review of 98 randomized clinical trials. Arch Fam Med. 1996 May;5(5):271–278. doi: 10.1001/archfami.5.5.271. [DOI] [PubMed] [Google Scholar]
- Coulson A. S., Glasspool D. W., Fox J., Emery J. RAGs: A novel approach to computerized genetic risk assessment and decision support from pedigrees. Methods Inf Med. 2001;40(4):315–322. [PubMed] [Google Scholar]
- Emery J., Walton R., Coulson A., Glasspool D., Ziebland S., Fox J. Computer support for recording and interpreting family histories of breast and ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients. BMJ. 1999 Jul 3;319(7201):32–36. doi: 10.1136/bmj.319.7201.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fox J., Johns N., Lyons C., Rahmanzadeh A., Thomson R., Wilson P. PROforma: a general technology for clinical decision support systems. Comput Methods Programs Biomed. 1997 Sep;54(1-2):59–67. doi: 10.1016/s0169-2607(97)00034-5. [DOI] [PubMed] [Google Scholar]
- Kinmonth A. L., Reinhard J., Bobrow M., Pauker S. The new genetics. Implications for clinical services in Britain and the United States. BMJ. 1998 Mar 7;316(7133):767–770. doi: 10.1136/bmj.316.7133.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ohno-Machado L., Gennari J. H., Murphy S. N., Jain N. L., Tu S. W., Oliver D. E., Pattison-Gordon E., Greenes R. A., Shortliffe E. H., Barnett G. O. The guideline interchange format: a model for representing guidelines. J Am Med Inform Assoc. 1998 Jul-Aug;5(4):357–372. doi: 10.1136/jamia.1998.0050357. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sweet Kevin M., Bradley Terry L., Westman Judith A. Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol. 2002 Jan 15;20(2):528–537. doi: 10.1200/JCO.2002.20.2.528. [DOI] [PubMed] [Google Scholar]