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Appl Clin Inform 2024; 15(02): 274-281
DOI: 10.1055/s-0044-1780511
Research Article

A Provider-Facing Decision Support Tool for Prostate Cancer Screening in Primary Care: A Pilot Study

Sigrid V. Carlsson
1   Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
2   Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
3   Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
4   Division of Urological Cancers, Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden
,
Mark A. Preston
5   Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Andrew Vickers
2   Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
Deepak Malhotra
6   Negotiation, Organizations, and Markets Unit, Harvard Business School, Boston, Massachusetts, United States
,
Behfar Ehdaie
1   Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
Michael J. Healey
7   Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Adam S. Kibel
5   Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding This project was supported by the Prevent Cancer Foundation. Work done by S.V.C., B.E., and A.V. was supported in part through a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30 CA008748) to Memorial Sloan Kettering Cancer Center. S.V.C. was further supported by a National Institutes of Health/National Cancer Institute Transition Career Development Award (K22 CA234400). A.S.K. is supported by the DiNovi Family Fund (U.S. Department of Health and Human Services).
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Abstract

Objectives Our objective was to pilot test an electronic health record-embedded decision support tool to facilitate prostate-specific antigen (PSA) screening discussions in the primary care setting.

Methods We pilot-tested a novel decision support tool that was used by 10 primary care physicians (PCPs) for 6 months, followed by a survey. The tool comprised (1) a risk-stratified algorithm, (2) a tool for facilitating shared decision-making (Simple Schema), (3) three best practice advisories (BPAs: <45, 45–75, and >75 years), and (4) a health maintenance module for scheduling automated reminders about PSA rescreening.

Results All PCPs found the tool feasible, acceptable, and clear to use. Eight out of ten PCPs reported that the tool made PSA screening conversations somewhat or much easier. Before using the tool, 70% of PCPs felt confident in their ability to discuss PSA screening with their patient, and this improved to 100% after the tool was used by PCPs for 6 months. PCPs found the BPAs for eligible (45–75 years) and older men (>75 years) more useful than the BPA for younger men (<45 years). Among the 10 PCPs, 60% found the Simple Schema to be very useful, and 50% found the health maintenance module to be extremely or very useful. Most PCPs reported the components of the tool to be at least somewhat useful, with 10% finding them to be very burdensome.

Conclusion We demonstrated the feasibility and acceptability of the tool, which is notable given the marked low acceptance of existing tools. All PCPs reported that they would consider continuing to use the tool in their clinic and were likely or very likely to recommend the tool to a colleague.

Keywords

prostate cancer screening - clinical decision support - electronic health record - pilot study - informatics - concordant care

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the Institutional Review Board at both BWH Primary Care and Memorial Sloan Kettering Cancer Center.


Disclaimer

The funding agencies had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit it for publication. The content is solely the responsibility of the authors.




Publication History

Received: 12 September 2023

Accepted: 19 January 2024

Article published online:
10 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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