M@X-Guide - ein wissensbasiertes System zur Unterstützung des Informed-Consents und des Shared-Decision-Makings am Beispiel der S3-Leitlinie zum metastasierten Mammakarzinom

Abstract

In the last 40 years more than 40 S3 guidelines for various medical fields were placed at public disposal by the AWMF alone. Although the guidelines are of high quality, the implementation of these until now has been inadequate due to incomplete contents and faulty implementation measures, therefore the targeted aims (e.g. improvement of the quality of treatment with simultaneous increase of cost-efficiency) cannot be reached and the potential of the guidelines is not fully exploited.The first part of this doctoral thesis examines the role of the guidelines from the viewpoint of the public healthcare system.After that a detail look of the German S3-guideline "Diagnostics, therapy and aftercare of breast cancer" on the treatment of metastatic breast cancer follows, together with a description of the strengths and weaknesses of this specific part of the guideline.The third chapter illuminates the problem from the point of view of information technology. Different approaches for the representation of knowledge in the medical field are examined for their efficiency to represent medical guidelines. This theoretic discussion is put intopractical experience by the implementation of M@X-Guide - the knowledge-based system for the therapy of metastatic breast cancer.The thesis is rounded by a detailed discussion of M@X-Guide, the possibility of supporting the implementation of medical guidelines using knowledge based systems, and the generalization of the findings in the form of a systematicprocess which would allow the construction of such systems on the basis of narrative guidelines.