Table 2.

Quantitative study descriptions and results

Reference	Description of decision support	Primary outcome	Results	Secondary outcomes	Results	Risk of bias scorea
Gerbert et al (2000)24	The eCDST comprised a clinical information form, decision tree, and support features. An algorithm embedded in the software uses clinical information entered by the GP to provide triage recommendations through a decision tree	Appropriateness of decision to triage skin lesion	Intervention: 86.7% Control: 63.3%	Appropriateness of triage decision for cancerous lesions	Intervention: 96.4% Control: 77.9%	High risk
				Appropriateness of triage decision for non-cancerous lesions	Intervention: 83.7% Control: 65.6%
				Mean change in physician performance (range = −15 to 15)	3.15, P<0.001
Jiwa et al (2006)35	An interactive pro forma requested information, through drop-down menus, for 15 clinical signs and symptoms identified as being significant in diagnosing CRC. Once the clinical data were entered in the pro forma, the interactive software offered the GP guidance on which cases needed urgent referral based on UK Department of Health guidelines. A referral letter was then automatically produced, seeking an appropriate appointment at a hospital clinic	Appropriateness of referral	Intervention: 14.2% Control: 19.4% RR 0.73 (95% CI = 0.46 to 1.15), P= 0.18	Assessment score of letters	Intervention: 2.4 Control: 2.1 Mean difference 0.3 (95% CI = 0.17 to 0.42), P<0.0001	Low risk
				Percentage of GPs who used the eCDST in intervention arm	18.1%
Kidney et al (2015)25	Clinical management software was modified to incorporate an algorithm that identifies patients who meet NICE (2005) urgent referral criteria for suspected CRC. The algorithm flagged up patients aged 60–79 years, who had diarrhoea or rectal bleeding for >6 months, or increased haemoglobin accompanied by iron deficiency anaemia. Patients without a previous diagnosis of CRC, whose records indicated that they met urgent referral criteria up to 2 years before the date of the search, were flagged. GPs reviewed the records of patients who were flagged and decided on further clinical management	Patients flagged and needing further review	34%	Percentage of CRC diagnosis in patients who were flagged	1.2%	Moderate risk
Logan et al (2002)26	Laboratory computers were programmed to print a decision prompt based on blood indices on the FBC report received by GPs. The intervention prompt stated ‘consistent with iron deficiency-? cause. Suggest treat with ferrous sulphate, 200 mg tds [three times a day] for 4 months, but check response in 3–4 weeks. Simultaneously investigate cause. Consider barium enema to exclude colorectal problems.’	Appropriateness of referral	Intervention: 45% Control: 49% OR 0.88 (95% CI = 0.60 to 1.29), P = 0.52	Oral iron prescribed	OR 2.19 (95% CI = 1.27 to 3.77), P = 0.005	Low risk
				Adequate dose of iron	OR 1.96 (95% CI = 1.24 to 3.10), P= 0.004
				Adequate course of iron	OR 1.26 (95% CI = 0.77 P= 0.36
				FBC repeated within 6 weeks	OR 0.85 (95% CI = 0.57 to 1.27), P= 0.43
				Normal haemoglobin within 1 year	OR 1.16 (95% CI = 0.74 to 1.80), P= 0.52
Murphy et al (2015)27 Meyer et al (2016)30	Electronic triggers were applied to electronic health record data repositories twice a month over a 15-month period to identify records of patients with potential delays in diagnostic evaluation of CRC, prostate cancer, or lung cancer. Electronic triggers identified ‘red-flag’ symptoms as: a positive FOBT, elevated PSA, iron deficiency anaemia, or hematochezia (blood in the stool). All trigger-positive records were initially considered to be high risk for delayed diagnostic evaluation. The records were then manually checked by study clinicians to determine whether delayed diagnostic evaluation had occurred. The patient’s GP was then contacted, including information about patient’s red flags. The information above was communicated to GPs in three escalating steps: first, secure emails were sent; if the GP did not follow up within 1 week, up to three telephone calls were made to either the GP or their nurse; if no one could be reached, clinic directors were informed	Median time to diagnostic evaluation27	Intervention versus control: Colorectal: 104 versus 200 days, P= 0.001 Prostate: 144 versus 192 days, P= 0.001 Lung: 65 versus 93 days, P= 0.59	Diagnostic evaluation at 7 months	Intervention: 73.4% Control: 52.2% RR 1.41 (95% CI = 1.25 to 1.58), P<0.001	Low risk
		Use of secure emails (cumulative response rate)30	11.1%	Response rates (by role)	GP: 67.9% Nurse: 69.7% P= 0.82
		Telephone calls (cumulative response rate)30	72.1%
		Contacting clinic directors (cumulative response rate)30	73.4%
Walter et al (2012)28	MoleMate is a computerised diagnostic tool that utilises spectrophotometric intracutaneous analysis (SIAscopy) integrated with a primary care scoring algorithm. Clinicians used the MoleMate system to assist their assessment and management of the suspicious lesion, deciding whether to refer patients through the fast-track skin cancer pathway or manage them in primary care.	Appropriateness of referral28	Intervention: 56.8% Control: 64.5% Percentage difference: −8.1% (95%CI = −18.0 to 1.8), P= 0.12	Appropriate management of skin lesions in primary care	Percentage difference 0.5 (95% CI = −0.6 to 2.0)	Low risk
Wilson et al (2013)31	The results of the RCT were used to estimate the expected long-term cost and health gain of the MoleMate system versus best practice	Incremental cost-effectiveness ratio31	£1896/QALY	Sensitivity	2.8 (95% CI = −1.8 to 7.4)
				Specificity	−6.2 (95% CI = −9.9 to −2.6)
Winkelmann et al (2015)29	MSDSLA analysed pigmented skin lesions and generates a ‘classifier score’. Participants were first asked if they would biopsy the lesion based on clinical images, then asked again after observing high-resolution dermoscopy images, and once more when subsequently shown MSDSLA probability information	Diagnostic accuracy	Intervention: 73% Control: 54% P<0.0001	Sensitivity	Intervention: 95% Control: 66% P<0.0001	High risk
				Specificity	Intervention: 55% Control: 46% P<0.0001

^aRisk of bias score calculated according to Joanna Briggs Institute Critical Appraisal Checklists.¹⁶ CI = confidence interval. CRC = colorectal cancer. eCDST = clinical decision support tool. FBC = full blood count. FOBT = faecal occult blood test. MSDSLA = multispectral digital skin lesion analysis. NICE = National Institute for Health and Care Excellence. OR = odds ratio. PSA = prostate-specific-antigen. QALY = quality-adjusted life year. RCT = randomised controlled trial. RR = relative risk.