Cancer Prevention Clinical Decision Support

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, a link from EHR data to evidence-based cancer prevention algorithms in a
secure Web site is created to: (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) and/or a key member of the primary care team, certified medical assistant
(CMA), appropriate evidence-based primary cancer prevention interventions and cancer
screening options at the point of care. The Cancer Prevention-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: PCP-focused CDS intervention in which the PCP triggers use
of the CDS system and engages patients in appropriate cancer prevention strategies. Group 2:
SDMT-focused CDS intervention in which the CMA triggers use of the CDS system along with
additional shared decision making tools and interacts with the patient to engage them in
appropriate cancer prevention strategies before seeing their PCP, who will approve or discuss
the plan with their patient. Group 3: clinics provide usual care 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 18-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.
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 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.

Inclusion Criteria:

- meet above age criteria

- pcp practice at randomized clinic

Exclusion Criteria:

- current or past cancer diagnosis (excludes nonmelanoma skin cancer)

- hospice care or cancer chemotherapy

- Alzheimer's disease codes

- major cardiovascular event in 12 months prior to index date