Abstract
BackgroundElectronic 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.MethodsThis 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.ResultsPre-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.ConclusionsWhile 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 registrationclinicaltrials.gov, NCT02986230, December 6, 2016.
Highlights
Electronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions
In this study, we found no significant differences in PCCs’ opinions on cancer prevention and screening questions related to breast, cervical, colorectal, or lung cancer or human papillomavirus (HPV) vaccination between the control arm receiving usual care (UC) and two CDS-focused intervention arms in a clinic-randomized control trial (RCT) prior to CDS implementation
The results of a qualitative study we conducted by interviewing 37 patients seen in 10 of the RCT’s intervention arm clinics immediately after their visits suggested that patients who discussed the CDS with their PCC during their visit may be more likely to make a choice regarding cancer prevention and screening than patients who received the CDS but did not review it with their PCP, a finding that future research should investigate further [6]. In this pre- and post-implementation survey study of a CDS intervention for cancer prevention and screening in primary care for patients due for breast, cervical, colorectal, or lung cancer screening or HPV vaccination, we found that most PCCs practicing in CDS intervention arms would recommend the CDS to colleagues and found it held value for patients and within their practice
Summary
Electronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions. A randomized control trial (RCT) of a web-based, patient-tailored, and EHR-linked CDS system, called “Priority Wizard” [15], targeted patients at risk for cardiovascular disease and showed a positive effect on both patients and clinicians by enhancing chronic disease health care for high-risk patients [15,16,17,18]. This CDS was updated to include targeted primary (human papillomavirus [HPV] vaccination, tobacco use, obesity) and secondary (breast, cervical, colorectal, lung) cancer prevention. It was unknown whether expanding the CDS to include cancer prevention and screening might impact PCCs’ opinions on the specific cancer prevention and screening areas included in the CDS
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