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Piloting a Clinical Decision Support System for Unintended Weight Loss in Primary Care: Mixed Methods Study on Early
Javiera Martinez-Gutierrez1,2,3, Sophie Chima1,2, Barbara Hunter1
1Department of General Practice and Primary Care, Melbourne Medical School, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, 3rd Floor Medical Building, Cnr Grattam Street and Royal Parade, Melbourne, Victoria, 3010, Australia, 61 136352.
A clinical decision support system (CDSS) for unintended weight loss (UWL) showed potential for early cancer detection in primary care. Despite implementation challenges like misclassification and workflow integration, high patient follow-up rates were observed, suggesting avenues for future CDSS improvements.
Area of Science:
- Primary Care Medicine
- Oncology
- Health Informatics
Background:
- Delayed cancer diagnosis significantly impacts patient outcomes.
- Unintended weight loss (UWL) is a nonspecific symptom often linked to cancer, complicating early detection.
- Clinical decision support systems (CDSSs) offer evidence-based guidance for timely diagnosis.
Purpose of the Study:
- To pilot the implementation of a CDSS designed to enhance early cancer detection in primary care patients presenting with UWL.
- To evaluate the acceptability and feasibility of the UWL CDSS among primary care staff.
Main Methods:
- Five primary care practices utilized a UWL CDSS to identify at-risk patients.
- Staff interviews, analyzed thematically, assessed CDSS acceptability and feasibility.
- Clinical audits evaluated UWL identification accuracy, follow-up rates, and patient characteristics.
Main Results:
- Of 60 identified patients, 36 (60%) had true UWL. Misclassification occurred, often due to undocumented intentional weight loss.
- Only 14% of patients with true UWL were actively recalled, yet 94% received follow-up care within six months.
- Staff found the CDSS concept acceptable, particularly those with quality improvement experience, but cited workflow integration and misclassification as barriers.
Conclusions:
- Implementing a CDSS for UWL in primary care presents both challenges and benefits for early cancer detection.
- High follow-up rates observed irrespective of formal recall warrant further investigation into Australian primary care practices and CDSS appropriateness.
- Future research should prioritize CDSS integration, improved classification accuracy (e.g., using AI), and workflow optimization to maximize CDSS potential in patient care.
