Abstract
BackgroundFew 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.MethodsWe 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.ResultsOf 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).ConclusionsMost 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 registrationclinicaltrials.gov, NCT02986230, December 6, 2016.
Highlights
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
Often times patients forgo low-dose Computed Tomography (LDCT) screening, most notably because they may not understand the information given to them, they do not think the test is worth the time, there are barriers that prevent them from getting the test done, they are concerned about getting a false-positive, or they do not want to know [7]
As we noted in a prior paper, “preliminary data from 2012 to 2014 among eligible Essentia Health patients aged 11–80 with two or more primary care visits within 36 months showed about twothirds are up to date on colorectal cancer screening, two-thirds up to date on breast cancer screening, 54% up to date on cervical cancer screening, and 5% of males aged 11–26 and 20% of females are up to date on Human papillomavirus (HPV) vaccination” (p. 2) [15]
Summary
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. While overall cancer death rates have dropped [2, 3], prevalence and lifetime risk of breast, cervical, colorectal, and lung cancer remain substantial [2], and screening rates are still insufficient. Often times patients forgo LDCT screening, most notably because they may not understand the information given to them, they do not think the test is worth the time, there are barriers that prevent them from getting the test done, they are concerned about getting a false-positive, or they do not want to know [7]. Cervical cancer may have the most benign screening method, the Pap smear [10], as well as an effective HPV vaccine that has struggled to achieve widespread uptake [11,12,13]
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