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Clinical Decision Support with or without Shared Decision Making to Improve Preventive Cancer Care: A

Thomas E Elliott1, Stephen E Asche1, Patrick J O'Connor1

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|February 25, 2022
PubMed
Summary

Clinical decision support (CDS) did not significantly improve cancer screening completion rates in rural areas. Further research is needed to understand the interaction between CDS and shared decision making (SDM) in cancer prevention.

Keywords:
clinical decision supportcluster-randomized trialelectronic health recordshealth informaticsimplementation researchpatient decision aidsprimary and secondary cancer preventionprimary carequality improvementrural healthshared decision making

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Area of Science:

  • Health Services Research
  • Preventive Medicine
  • Rural Health

Background:

  • Innovative interventions are crucial for improving preventive cancer care, particularly in underserved rural regions.
  • Gaps in cancer screening completion necessitate novel approaches to enhance patient outcomes.
  • This study addresses the need for effective strategies to increase cancer screening rates in primary care settings.

Purpose of the Study:

  • To evaluate the impact of clinical decision support (CDS) on cancer-screening completion.
  • To assess the added benefit of shared decision making (SDM) combined with CDS in improving cancer screening rates.
  • To compare the effectiveness of CDS, CDS plus SDM, and usual care in a rural primary care setting.

Main Methods:

  • A 3-arm, parallel-group, cluster-randomized trial involving 34 primary care clinics in a rural medical group.
  • Interventions included clinical decision support (CDS), CDS plus shared decision making (CDS+SDM), and usual care (UC).
  • The primary outcome measured was the proportion of patients overdue for breast, cervical, or colorectal cancer screening who were up to date 1 year later.

Main Results:

  • The study included 69,405 patients, with 25,198 overdue for screening at baseline.
  • At 12-month follow-up, 37.9% of overdue patients were up to date on composite cancer screening.
  • Adjusted screening completion rates were 36.5% (UC), 38.1% (CDS), and 34.4% (CDS+SDM), with no statistically significant differences between groups.

Conclusions:

  • Clinical decision support (CDS) alone or with shared decision making (SDM) did not significantly increase cancer-screening completion rates in this rural population.
  • Exploratory analyses indicate a need for further investigation into the complex interactions between CDS and SDM in cancer prevention decision-making.
  • The findings highlight the challenges in implementing and optimizing digital health tools for preventive care in diverse healthcare settings.