Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial

Elliott, Thomas E.; O’Connor, Patrick J.; Asche, Stephen E.; Saman, Daniel M.; Dehmer, Steven P.; Ekström, Heidi; Allen, Clayton I.; Bianco, Joseph A.; Chrenka, Ella; Freitag, Laura A.; Harry, Melissa L.; Truitt, Anjali R.; Sperl-Hillen, JoAnn M.

doi:10.1016/j.cct.2021.106271

Cited by 11 publications

(63 citation statements)

References 51 publications

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“…Because this was a paper reporting exploratory patient survey results, we did not report model-based results that controlled for any potential clinic-level differences. All clinics were balanced prior to randomization [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey

Saman

Chrenka

Harry

et al. 2021

BMC Health Serv Res

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Background Few studies have assessed the impact of clinical decision support (CDS), with or without shared decision-making tools (SDMTs), on patients’ perceptions of cancer screening or prevention in primary care settings. This cross-sectional survey was conducted to understand primary care patient’s perceptions on cancer screening or prevention. Methods We mailed surveys (10/2018–1/2019) to 749 patients aged 18 to 75 years within 15 days after an index clinical encounter at 36 primary care clinics participating in a clinic-randomized control trial of a CDS system for cancer prevention. All patients were overdue for cancer screening or human papillomavirus vaccination. The survey compared respondents’ answers by study arm: usual care; CDS; or CDS + SDMT. Results Of 387 respondents (52% response rate), 73% reported having enough time to discuss cancer prevention options with their primary care provider (PCP), 64% reported their PCP explained the benefits of the cancer screening choice very well, and 32% of obese patients reported discussing weight management, with two-thirds reporting selecting a weight management intervention. Usual care respondents were significantly more likely to decide on colorectal cancer screening than CDS respondents (p < 0.01), and on tobacco cessation than CDS + SDMT respondents (p = 0.02) and both CDS and CDS + SDMT respondents (p < 0.001). Conclusions Most patients reported discussing cancer prevention needs with PCPs, with few significant differences between the three study arms in patient-reported cancer prevention care. Upcoming research will assess differences in screening and vaccination rates between study arms during the post-intervention follow-up period. Trial registration clinicaltrials.gov, NCT02986230, December 6, 2016.

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Section: Discussionmentioning

confidence: 99%

“…Participants included in the usual care study arm would have met the criteria for the CDS if they visited an intervention clinic. We recently published a paper outlining the design of the RCT [ 28 ]. Results of the RCT will be published separately.…”

Section: Methodsmentioning

confidence: 99%

The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey

Saman

Chrenka

Harry

et al. 2021

BMC Health Serv Res

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“…Primary care clinicians (PCCs) manage multiple complex medical issues for a wide variety of patients, as well as must stay on top of patients' preventative health care [1][2][3][4][5][6][7][8][9]. Given competing priorities, limited visit time, and the areas of importance for patients, cancer prevention and screening may be overlooked by both patients and PCCs [1, 4, 6-8, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

“…Given competing priorities, limited visit time, and the areas of importance for patients, cancer prevention and screening may be overlooked by both patients and PCCs [1, 4, 6-8, 10, 11]. Workable solutions are needed that adapt into clinic workflow, such as algorithm-based clinical decision support (CDS) systems connected with the electronic health record (EHR) [1,2,4,[6][7][8]. CDS can be used to help facilitate health care and save PCCs time and effort by: identifying numerous health care needs through instantly reviewing the EHR; alerting the user to context-specific knowledge; and assisting with medical decision-making [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…The objective of this exploratory study was to understand how the cancer prevention and screening CDS impacted PCCs' views in a three arm, clinic cluster-RCT. One intervention arm implemented the CDS with cancer prevention and screening (breast, cervical, colorectal, and lung cancer and HPV vaccination) (CDS arm), the other intervention arm implemented the CDS cancer prevention and screening components with the addition of shared decision-making tools (SDMT) for breast, colorectal, and lung cancer screening and HPV vaccination (CDS + SDMT arm), and the third arm employed the usual care (UC) cancer prevention and screening patients received within the healthcare system (UC arm) [1,2,4,[6][7][8]. The primary aim of this study was to examine differences in PCC opinions within study arms between pre-and post-intervention implementation.…”

Section: Introductionmentioning

confidence: 99%

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Primary care clinicians’ opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study

Harry

Chrenka

Freitag

et al. 2022

BMC Health Serv Res

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Background Electronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions. As part of a clinic cluster-randomized control trial (RCT) testing a cancer prevention and screening CDS system with patient and PCC printouts (with or without shared decision-making tools [SDMT]) for patients due for breast, cervical, colorectal, and lung cancer screening and/or human papillomavirus (HPV) vaccination compared to usual care (UC), we surveyed PCCs at study clinics pre- and post-CDS implementation. Our primary aim was to learn if PCCs' opinions changed over time within study arms. Secondary aims including examining whether PCCs' opinions in study arms differed both pre- and post-implementation, and gauging PCCs’ opinions on the CDS in the two intervention arms. Methods This study was conducted within a healthcare system serving an upper Midwestern population. We administered pre-implementation (11/2/2017–1/24/2018) and post-implementation (2/2/2020–4/9/2020) cross-sectional electronic surveys to PCCs practicing within a RCT arm: UC; CDS; or CDS + SDMT. Bivariate analyses compared responses between study arms at both time periods and longitudinally within study arms. Results Pre-implementation (53%, n = 166) and post-implementation (57%, n = 172) response rates were similar. No significant differences in PCC responses were seen between study arms on cancer prevention and screening questions pre-implementation, with few significant differences found between study arms post-implementation. However, significantly fewer intervention arm clinic PCCs reported being very comfortable with discussing breast cancer screening options with patients compared to UC post-implementation, as well as compared to the same intervention arms pre-implementation. Other significant differences were noted within arms longitudinally. For intervention arms, these differences related to CDS areas like EHR alerts, risk calculators, and ordering screening. Most intervention arm PCCs noted the CDS provided overdue screening alerts to which they were unaware. Few PCCs reported using the CDS, but most would recommend it to colleagues, expressed high CDS satisfaction rates, and thought patients liked the CDS’s information and utility. Conclusions While appreciated by PCCs with high satisfaction rates, the CDS may lower PCCs’ confidence regarding discussing patients’ breast cancer screening options and may be used irregularly. Future research will evaluate the impact of the CDS on cancer prevention and screening rates. Trial registration clinicaltrials.gov, NCT02986230, December 6, 2016.

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Shared decision-making for supporting women’s decisions about breast cancer screening

Riganti,

Ruiz Yanzi,

Escobar Liquitay

et al. 2024

Cochrane Database of Systematic Reviews

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Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial

Cited by 11 publications

References 51 publications

The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey

The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey

Primary care clinicians’ opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study

Shared decision-making for supporting women’s decisions about breast cancer screening

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