Pd26-11 Initial Evaluation of Adherence to an Electronic Decision Support Tool for Shared Decision Making in Prostate Cancer Screening in the Primary Care Setting

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD26)1 May 2024PD26-11 INITIAL EVALUATION OF ADHERENCE TO AN ELECTRONIC DECISION SUPPORT TOOL FOR SHARED DECISION MAKING IN PROSTATE CANCER SCREENING IN THE PRIMARY CARE SETTING Jillian Egan, Sigrid V. Carlsson, Andrew Vickers, Nnamdi O. Onochie, Adam S. Kibel, and Michael Healey Jillian EganJillian Egan , Sigrid V. CarlssonSigrid V. Carlsson , Andrew VickersAndrew Vickers , Nnamdi O. OnochieNnamdi O. Onochie , Adam S. KibelAdam S. Kibel , and Michael HealeyMichael Healey View All Author Informationhttps://doi.org/10.1097/01.JU.0001008556.20565.76.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several guidelines exist to direct appropriate PSA screening with the goal of maximizing benefits while reducing the harms of over diagnosis and treatment. However, these guidelines are frequently not followed. PSA screening continues to be low in the men most likely to benefit and high in those older men where there is clear evidence of harm. In many instances, PSA screening is initiated in the primary care setting. Therefore, we hypothesized that a tool embedded in the electronic health record designed to guide shared decision making (SDM) conversations and advise on best screening practices would improve guideline concordant care in the early detection of prostate cancer. METHODS: A novel tool to aid in PSA screening at the primary care level was introduced to the electronic medical record in 9 primary care practices. This was part of a larger, cluster randomized control trial across 15 practices in Boston, MA, with randomization performed at the practice level. The intervention consisted of 4 components: 1) a risk- stratified algorithm for PSA screening; 2) a provider-facing tool specifically developed for facilitating shared decision-making (SDM) conversations; 3) three non-interruptive best practice advisories (BPA) for eligible (age 45-70) and not eligible (age<45 and>70) patients for PSA screening; 4) a health maintenance module aimed at setting automatic reminders for PSA screening at guideline-based intervals. The primary outcome was interaction with the BPA in the intervention arm; secondary outcomes included rate of SDM and PSA screening. Analysis was performed using STATA 17.0. RESULTS: There were a total 12,107 patient visits across 278 providers randomized to intervention from 7/2022 – 5/2023. The majority had no prior PSA (7,942, 66%). 1,366 (11%) had prior PSA<1 ng/mL; 2,302 (19%) had a prior PSA 1-3 ng/mL; 497 (4.1%) had a prior PSA>3 ng/mL. Most visits did not involve interaction with the BPA (11,039, 91%, [88- 93%]). Of those that did, SDM was completed in 74%. There was a difference in rate of PSA orders in those visits where BPA was utilized versus not (24 vs 17%, p<0.0001) and those where SDM was completed versus not (32 vs 17%, p<0.0001). In visits where SDM was completed, there was no difference in the rate of PSA orders based on prior PSA (32%, 28%, 39%, 29% for no prior PSA, PSA<1, PSA 1-3 and PSA>3, respectively; p=0.33). CONCLUSIONS: Given its non-interruptive nature, it is not surprising that 91% of PCPs did not interact with the BPA. However, in those patients where the BPA was utilized, the rate of guideline appropriate PSA screening increased. An even larger increase was seen in those patients where SDM was performed. SDM resulted in a PSA test in only 1/3 of eligible patients, with no difference based on prior PSA values. These findings suggest making the BPA interruptive may improve interaction and has the potential to improve rates of guideline concordant prostate cancer screening. Further work is needed to determine why 2/3 of patients and/or providers decline PSA after SDM. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e549 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jillian Egan More articles by this author Sigrid V. Carlsson More articles by this author Andrew Vickers More articles by this author Nnamdi O. Onochie More articles by this author Adam S. Kibel More articles by this author Michael Healey More articles by this author Expand All Advertisement PDF downloadLoading ...