Piloting electronic screening forms in primary care: findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening

Abstract

BackgroundRecent evidence suggests that screening with low dose computed tomography (LDCT) scans significantly reduces mortality from lung cancer. However, optimal methods to identify potentially eligible patients in primary care are not known. Using brief electronic screening forms administered prior to a primary care visit is a strategy to identify high risk, asymptomatic patients eligible for LDCT screening. The objective of this study was to compare the acceptability and feasibility of using brief electronic versus paper screening forms to identify eligible patients at high risk of developing lung cancer in primary care.MethodsA mixed method pilot comparative study was conducted in primary care. Practices were allocated to an electronic form (e-form) group or a paper-based form (p-form) group. Allocation was randomly assigned for the first practice then by alternation. Patients in the e-form practices completed forms at home via the web or in the waiting room on a tablet. Patients in p-form practices completed forms in waiting rooms. Interviews were conducted with patients, administrators, and primary care physicians (PCPs) about their experiences.ResultsSix of 30 (20%) eligible practices agreed to participate. Over the 16-week study period, a total of 831 of an expected 1442 patients (58%) aged 55–74 years were enrolled; 573/690 (83%) patients in the e-form group and 258/752 (34%) in the p-form group. Of the 573 participants in the e-form group, 335 (58%) completed forms via the web; 238 (29%) did so via tablet. Twenty-four interviews were conducted with 15 patients, 5 administrative staff and 4 PCPs. Patients were willing to discuss lung cancer screening eligibility with their PCP. Staff members expressed low administrative burden except for an extra step to link appointment information to patient demographics to identify eligible patients. PCPs indicated that forms were reminders to discuss smoking cessation. PCPs in the e-form group reported that patients asked questions about screening.ConclusionThere was fairly low uptake by primary care practices. For e-forms to be feasible in practice workflow, electronic medical record software needs to link appointment information with patient eligibility requirements. The use of brief pre-consultation electronic screening forms for LDCT eligibility encouraged PCPs to discuss smoking cessation with patients.

Primary care providers’ views on a future lung cancer screening program

“…This descriptive qualitative study (11) was one of five components of a health technology assessment on LDCT screening in Ontario, Canada (Principal Investigator: L Paszat)). The other components were 1) modelling benefits, risks, and cost effectiveness (12), 2) a feasibility study of an electronic pre-screening form in primary care (13), 3) a qualitative study of the views of both individuals who were long-time smokers and PCPs, and 4) the creation of a risk assessment tool.…”

Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

“… 371 counselees +++ Breast cancer genetic counseling clinic Netherlands Breast cancer Patient education Demographic data, Patient awareness Patient satisfaction, Medication and treatment adherence, Illness perceptions, and knowledge 15 34 Frost, J. et al [ 31 ] 2019 BMJ Open Electronic pre-office visit checklist To explore the impact of a pre-consultation website in addressing patients’ unmet needs during chronic disease consultations. 120 patients and 15 diabetologists +++ Diabetes clinics UK Diabetes Decision aid tools, Pre-assessment tools, Patient education Demographic data, Medical history, Lifestyle, Family history, Lab data, Reason for referral, Drug side effects Symptoms, Medication Appointment intake information, Visit length 17 35 O’Brien, M et al [ 32 ] 2017 BMC Fam Pract Electronic pre-office visit checklist To investigate people’s attitude towards providing symptom information electronically before a consultation. 831 patients + Family physician’s clinic Canada Lung cancer Decision aid tools, Pre-assessment tools, Patient education Demographic data, Medical history, Lifestyle, Family history, Lab data, Reason for referral, Drug side effects Symptoms, Medication Illness perceptions, Patient expectations in consultations, Appointment intake information, Medication and treatment adherence, Mental health topics 20 36 Wald, J. S. et al [ 43 ] 2009 AMIA Annu Symp Proc EHR-linked care program To investigate the potential of e-journal to improve patient care during a visit 126 patients and 230 primary care providers +++ Primary care USA Diabetes Decision aid tools, Pre-assessment tools, Patient education, Reminders Demographic data, Medical history, Lifestyle, Family history, Lab data, Reason for referral, Drug side effects Symptoms, Medication Appointment intake information, Self-care, Symptom control, Visit length, 16 37 Albertson, G. et al [ …”

Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States

“…Educational and organizational efforts that have targeted physicians regarding shared decision-making with their patients for LDCT screening have had some preliminary success in modifying physician knowledge, attitudes, and screening behavior. These approaches have included a digital awareness campaign ( Jessup et al, 2018 ), electronic eligibility form for patients ( O’Brien et al, 2017 ), lectures and group-based learning ( Ortmeyer et al, 2020 ), and a decision aid ( McDonnell et al, 2018 ). Due to the lack of evidence regarding effectiveness of certain screening tests such as PSA, physicians should thoroughly discuss with patients the individual benefits versus the overall risks of screening.…”