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

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

Abstract

Background: Despite decades of research the gap in primary and secondary cancer prevention services in the U. S. remains unacceptably wide. Innovative interventions are needed to address this persistent challenge. Electronic health records linked with Web-based clinical decision support may close this gap, especially if delivered to both patients and their providers.

Objectives: The Cancer Prevention Wizard (CPW) study is an implementation, clinic-randomized trial designed to achieve these aims: 1) assess impact of the Cancer Prevention Wizard-Clinical Decision Support (CPW-CDS) alone and CPW-CDS plus Shared Decision Making Tools (CPW + SDMTs) compared to usual care (UC) on tobacco cessation counseling and drugs, HPV vaccinations, and screening tests for breast, cervical, colorectal, or lung cancer; 2) assess cost of the CPW-CDS intervention; and 3) describe critical facilitators and barriers for CPW-CDS implementation, use, and clinical impact using a mixed-methods approach supported by the CFIR and RE-AIM frameworks.

Methods: 34 predominantly rural, primary care clinics were randomized to CPW-CDS, CPW + SMDTs, or UC. Between August 2018 and October 2020, primary care providers and their patients who met inclusion criteria in intervention clinics were exposed to the CPW-CDS with or without SDMTs. Study outcomes at 12 months post index visit include patients up to date on screening tests and HPV vaccinations, overall healthcare costs, and diagnostic codes and billing levels for cancer prevention services.

Conclusions: We will test in rural primary care settings whether CPW-CDS with or without SDMTs can improve delivery of primary and secondary cancer prevention services. The trial and analyses are ongoing with results expected in 2021.

Keywords: Clinical decision support; Cluster-randomized trial; Health informatics; Implementation research; Primary & secondary cancer prevention; Shared decision making.

Conflict of interest statement

Conflict of interest disclosures

No author had conflicts to report.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Figure 1.
Figure 1.
Study Flowchart
Figure 2.
Figure 2.
Active guidelines embeds a direct link to ordering based on prioritized recommendations
Figure 3.
Figure 3.
Provider interface shows priorities, labs, and considerations
Figure 4.
Figure 4.
Printable patient interface shows priorities displayed in symbol form, goals and recommendations
Figure 5.
Figure 5.
CDS Design Flow
Figure 5.
Figure 5.
CDS Design Flow
Figure 6.
Figure 6.
Risk assessment tool

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Source: PubMed

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