Patient care is becoming increasingly complex and multidisciplinary for many conditions, notably cancer and chronic diseases, in which a care team participates in and shares responsibility for the patient's care. Providing IT support for joint clinical decision making in an open and distributed environment raises some challenges that are worth our attention: 1) new clinical evidence and guidelines, published by healthcare authorities and subject to continuous revision, need to be shared and

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... ted by the care team, as automatically as possible; 2) clinical specialists, located in their own working environments, need to be able to group together wherever necessary; 3) decision points, distributed in the environment, need to refer consistently the same set of guidelines and unless these are well-coordinated across the care team, safe delivery of care will be hard to guarantee. In this paper we propose an open and adaptive agent architectural model to resolve these challenges. This is based on an Agent-oriented Model Driven Architecture and a decision support management model, which are integrated to support joint clinical decision-making.