• Polina V Kukhareva, Haojia Li, Tanner J Caverly, Guilherme Del Fiol, Angela Fagerlin, Jorie M Butler, Rachel Hess, Yue Zhang, Teresa Taft, Michael C Flynn, Chakravarthy Reddy, Douglas K Martin, Isaac A Warner, Salvador Rodriguez-Loya, Phillip B Warner, and Kensaku Kawamoto.
• Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
• Chest. 2023 Nov 1; 164 (5): 132513381325-1338.

BackgroundAlthough low-dose CT (LDCT) scan imaging lung cancer screening (LCS) can reduce lung cancer mortality, it remains underused. Shared decision-making (SDM) is recommended to assess the balance of benefits and harms for each patient.Research QuestionDo clinician-facing electronic health record (EHR) prompts and an EHR-integrated everyday SDM tool designed to support routine incorporation of SDM into primary care improve LDCT scan imaging ordering and completion?Study Design And MethodsA preintervention and postintervention analysis was conducted in 30 primary care and four pulmonary clinics for visits with patients who met United States Preventive Services Task Force criteria for LCS. Propensity scores were used to adjust for covariates. Subgroup analyses were conducted based on the expected benefit from screening (high benefit vs intermediate benefit), pulmonologist involvement (ie, whether the patient was seen in a pulmonary clinic in addition to a primary care clinic), sex, and race and ethnicity.ResultsIn the 12-month preintervention phase among 1,090 eligible patients, 77 patients (7.1%) had LDCT scan imaging orders and 48 patients (4.4%) completed screenings. In the 9-month intervention phase among 1,026 eligible patients, 280 patients (27.3%) had LDCT scan imaging orders and 182 patients (17.7%) completed screenings. Adjusted ORs were 4.9 (95% CI, 3.4-6.9; P < .001) and 4.7 (95% CI, 3.1-7.1; P < .001) for LDCT imaging ordering and completion, respectively. Subgroup analyses showed increases in ordering and completion for all patient subgroups. In the intervention phase, the SDM tool was used by 23 of 102 ordering providers (22.5%) and for 69 of 274 patients (25.2%) for whom LDCT scan imaging was ordered and who needed SDM at the time of ordering.InterpretationClinician-facing EHR prompts and an EHR-integrated everyday SDM tool are promising approaches to improving LCS in the primary care setting. However, room for improvement remains. As such, further research is warranted.Trial RegistryClinicalTrials.gov; No.: NCT04498052; URL: www.Clinicaltrialsgov.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

15 keywords...

hide…