Cancer Prevention Clinical Decision Support
Condition: Cancer Prevention
Study type: Interventional

Summary: 
      The objective of this project is to implement and evaluate the effectiveness of a
      sophisticated Web-based, electronic health record (EHR)-linked clinical decision support
      (CDS) system designed to improve primary and secondary cancer preventive care.

      This project will engage a rural population with substantial healthcare disparities and gaps
      in the receipt of primary and secondary cancer prevention. Results will advance dissemination
      and implementation research methods that can reduce health disparities and improve healthcare
      for millions in medically under-served areas.
    

Detailed description: 
      The objective of this project is to implement and evaluate the effectiveness of a
      sophisticated Web-based, electronic health record (EHR)-linked clinical decision support
      (CDS) system designed to improve primary and secondary cancer preventive care. To achieve
      this objective, EHR data is sent to evidence-based cancer prevention algorithms, housed on a
      secure Web site. The algorithms: (a) identify at the point of care all eligible patients not
      up to date on their cancer prevention interventions; and (b) present to both patient and
      primary care provider (PCP), appropriate evidence-based primary cancer prevention
      interventions and cancer screening options at the point of care. The cancer prevention
      (CP)-CDS will focus on breast cancer screening in women aged 50-74, colorectal cancer
      screening for both sexes aged 50-75, cervical cancer screening for women aged 21-65, human
      papilloma virus (HPV) vaccination for both sexes aged 11-26, and referrals for weight
      management and smoking cessation in all adults aged 18 and older. Effectiveness is assessed
      by cluster-randomizing 30 primary care clinics with roughly 285 PCPs and 153,000
      study-eligible patients into one of three experimental conditions: Group 1: CP-CDS
      intervention in which the decision support is printed for the PCP and patient, designed to
      engage patients in discussions about appropriate cancer prevention strategies. Group 2:
      CP-CDS + shared decision making tools (SDMT) intervention in which the CP-CDS is printed
      along with additional shared decision making tools. Group 3: clinics provide usual care (UC)
      with no intervention-related activity related to cancer prevention.

      With 10 clinics, 95 PCPs, and 51,000 potentially eligible patients per study arm, this study
      will formally test the hypothesis that Groups 1 and 2 are superior to Group 3 over an
      12-month follow-up period with respect to: (a) significantly higher rates of appropriate
      screening for breast, cervix, and colorectal cancer, as defined by the United States
      Preventive Services Task Force; and (b) significantly higher rates of human papillomavirus
      (HPV) vaccination in males and females aged 11-26 years. Secondary analysis will evaluate the
      impact of the intervention on lung cancer screening. The investigators further posit that
      Groups 1 and 2 will have higher short-term health care costs but better long-term
      cost-effectiveness than Group 3. The Consolidated Framework for Implementation Research
      (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)
      conceptual frameworks will be used to guide implementation planning, organization, conduct,
      and impact evaluation of the intervention in a large rural healthcare system.

      This project will engage a rural population with substantial healthcare disparities and gaps
      in the receipt of primary and secondary cancer prevention. Results will advance dissemination
      and implementation research methods that can reduce health disparities and improve healthcare
      for millions in medically under-served areas.
    

Intervention name(s): CP-CDS
Intervention type(s): Other
Intervention description(s): The cancer prevention wizard is a point of care clinical decision support system designed to identify patients that are due for preventative cancer services and provides evidenced-based recommendations to the patient and provider.
Other intervention name(s): Cancer Prevention Wizard
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Cancer prevention; Clinical Decision Support; Rural Health; Shared Decision Making