Implementation of Provider-Facing Interventions to Increase Uptake of Endoscopic Screening for Esophageal...

Screening uptake among individuals at high-risk for esophageal adenocarcinoma and gastric cardia adenocarcinoma remains poor. We conducted a pilot study to evaluate the real-world implementation of 2 approaches for endoscopic screening uptake in high-risk individuals identified by an automated risk assessment tool, with the aim of identifying facilitators, barriers, and implementation gaps.

Pilot 1 involved notifying primary care provider (PCPs) of patients at high risk and due for colorectal cancer screening. Pilot 2 used nurse outreach to offer esophagogastroduodenoscopy (EGD) to high-risk patients scheduling a screening colonoscopy. The primary outcome was feasibility - EGD ordered among eligible patients. Secondary outcomes included EGD completion and acceptability, assessed through semistructured interviews with patients, PCPs, gastroenterologists, and facility leadership.

In Pilot 1, PCPs were notified of 97 high-risk patients; EGDs were ordered in 28 (29%) and completed in 15 (54% of ordered). If colorectal cancer screening was ordered, PCPs were more likely to discuss esophageal adenocarcinoma/gastric cardia adenocarcinoma risk (69% vs 36%, P < .01). EGD was more likely ordered if colonoscopy was ordered vs fecal testing (88% vs 39%, P < .01). In Pilot 2, 9 of 86 eligible patients were contacted; EGDs ordered for 6 (7%) and completed in all 6 (100% of ordered). Providers valued decision support tools and automatic electronic health record alerts, but cited lack of supporting evidence, guideline recommendations, and clinic time as barriers.

Both provider notifications and nurse outreach demonstrated high acceptability and completion but limited feasibility for increasing EGD orders due to provider and system-level barriers, highlighting implementation gaps and targets for guideline and workflow integration.