Journal Article

Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study

Henzler-Buckingham, Hillary A., Elliott, Thomas E., Bianco, Joseph A., Allen, Clayton I., Walton, Kayla M., O’Connor, Patrick J., Harry, Melissa L., Ekstrom, Heidi L., Truitt, Anjali R., Sperl-Hillen, JoAnn M., Saman, Daniel M.

2019

Overview

Background In the United States, primary care providers (PCPs) routinely balance acute, chronic, and preventive patient care delivery, including cancer prevention and screening, in time-limited visits. Clinical decision support (CDS) may help PCPs prioritize cancer prevention and screening with other patient needs. In a three-arm, pragmatic, clinic-randomized control trial, we are studying cancer prevention CDS in a large, upper Midwestern healthcare system. The web-based, electronic health record (EHR)-linked CDS integrates evidence-based primary and secondary cancer prevention and screening recommendations into an existing cardiovascular risk management CDS system. Our objective with this study was to identify adoption barriers and facilitators before implementation in primary care. Methods We conducted semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) with 28 key informants employed by the healthcare organization in either leadership roles or the direct provision of clinical care. Transcribed interviews were analyzed using qualitative content analysis. Results EHR, CDS workflow, CDS users (providers and patients), training, and organizational barriers and facilitators were identified related to Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals CFIR domains. Conclusion Identifying and addressing key informant-identified barriers and facilitators before implementing cancer prevention CDS in primary care may support a successful implementation and sustained use. The CFIR is a useful framework for understanding pre-implementation barriers and facilitators. Based on our findings, the research team developed and instituted specialized training, pilot testing, implementation plans, and post-implementation efforts to maximize identified facilitators and address barriers. Trial registration clinicaltrials.gov , NCT02986230 , December 6, 2016.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Cancer patients / Cancer prevention / Cancer research / Cancer screening / Cardiovascular diseases / Clinical decision support / Clinical trials / Decision making / Decision Support Systems, Clinical - organization & administration / Electronic records / Evidence-based medicine / Health Administration / Health aspects / Health Informatics / Humans / Informers / Key informants / Management / Medical records / Medicine / Medicine & Public Health / Methods / Neoplasms - prevention & control / Nursing Research / Organization / Patient care / Physicians, Primary Care - psychology / Pre-implementation / Primary and secondary prevention / Primary care / Primary health care / Primary Health Care - organization & administration / Public Health / Qualitative Research / Research Article / structure and delivery of healthcare / United States / Workflow software