Table 3.

Summary of primary research on CDS systems for cancer-related GPM: genotype-driven CDS tools for breast cancer management

Citation and name of system (if applicable)	Manuscript summary and trial details (if applicable)	Users and study location	Genetic information used	Integrated with primary clinical information system	CDS purpose and clinical focus	Manuscript type	Notable informatics aspect
Schwartz, 200928	RCT of patient-facing tool that captured patient-specific information and provided tailored content about risks, benefits and management options based on the patients' particular situations. This study found that among 214 BRCA-positive women who were initially undecided about how to manage their breast cancer risk, patients who used the CDS tool were more likely to reach a management decision (p=0.001), had decreased decision conflict (p=0.002), and increased satisfaction (p=0.002) compared to women who did not use the CDS tool	Patients in USA	Genotype	No	Provision of management recommendations for breast cancer	RCT	CD-ROM based, patient-directed decision aid
Hooker, 201129	Longitudinal RCT of patient-facing BRCA decision aid.28 This study showed significantly higher cancer-specific distress (p=0.01) and genetic testing-specific distress (p=0.01) among users of the personalized decision aid after one month. Distress levels between groups were the same after 12 months	Patients in USA	Genotype	No	Provision of management recommendations for breast cancer	RCT	CD-ROM based, patient-directed decision aid
Glasspool, 200730; REACT	System description of REACT (Risks, Events, Actions and their Consequences over Time), a breast cancer CDS tool with a graphical timeline display to model real-time changes in lifetime risk as a result of risk-reduction interventions such as tamoxifen therapy, hormone therapy, and mastectomy	Genetic counselors in UK	Genotype	No	Prediction of response to treatment for breast and ovarian cancer	System description	Graphical display of risk changes dynamically based on selected interventions
Glasspool, 201031; REACT	Qualitative study of REACT by eight genetic counselors.30 Most counselors found REACT effective for genetic risk management, although there were concerns related to the tool's potential to alter the dynamics of the clinician–patient interaction	Genetic counselors in UK	Genotype	No	Prediction of response to treatment for breast and ovarian cancer	Qualitative study	Graphical display of risk changes dynamically based on selected interventions

CDS, clinical decision support; GPM, genetically guided personalized medicine; RCT, randomized controlled trial; REACT, Risks, Events, Actions and their Consequences over Time.