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

Daniel M Saman, Ella A Chrenka, Melissa L Harry, Clayton I Allen, Laura A Freitag, Stephen E Asche, Anjali R Truitt, Heidi L Ekstrom, Patrick J O'Connor, JoAnn M Sperl-Hillen, Jeanette Y Ziegenfuss, Thomas E Elliott, Daniel M Saman, Ella A Chrenka, Melissa L Harry, Clayton I Allen, Laura A Freitag, Stephen E Asche, Anjali R Truitt, Heidi L Ekstrom, Patrick J O'Connor, JoAnn M Sperl-Hillen, Jeanette Y Ziegenfuss, Thomas E Elliott

Abstract

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.

Keywords: Cancer prevention; Cancer screening; Clinical decision support; Decision aid; Electronic health record; Patient survey.

Conflict of interest statement

The authors declare that they have no competing interests.

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Source: PubMed

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