Low Burden Electronic Health Record (EHR) Strategies for Engaging Oncologists in Digital Health Behavior Change Interventions: A Qualitative Study. (Preprint)

BACKGROUND Digital health behavior change interventions play an important role in helping cancer survivors improve their quality of life and reduce the risk of cancer recurrence. Clinician-patient communication is central to promoting the uptake of and adherence to digital health behavior change interventions. However, oncologists face significant barriers including time-constraints, knowledge gaps and conversational uneasiness that limit risk behavior and health behavior change conversations. OBJECTIVE The aim of this qualitative study is to explore oncologists’ preferences for discussing and monitoring risk behaviors with cancer survivors, with a specific focus on conversations about digital health behavior change interventions. The study also explored oncologists’ informational and technological support requirements to facilitate these conversations. METHODS We conducted semi-structured interviews with 18 oncologists who provide cancer care within a large National Cancer Institute (NCI)-designated comprehensive cancer center. The transcripts and interview notes were analyzed through an iterative thematic analysis to generate relevant themes and categories. RESULTS Oncologists expressed a desire for two action-oriented communication mechanisms for promoting digital health behavior change: referring patients to interventions and reinforcing intervention goals longitudinally. To facilitate risk behavior and health behavior change conversations, their support needs include preference for low-burden, EHR-integrated tools providing timely updates on patient enrollment and progress. Participating oncologists requested a tailored conversation aid for patient communication and parallel systems combining EHR messaging with print materials. They also emphasized the need for automated recommender systems to identify and refer eligible patients and reminder systems to prompt timely discussions with patients. CONCLUSIONS Oncologists are motivated and well-positioned to support patients' health behavior change but have unmet informational and technological requirements. Based on oncologists' perspectives, our findings provide actionable, user-centered, low-burden strategies for facilitating oncologist-patient conversations about digital health behavior change interventions. We make recommendations for integrating these strategies directly into the electronic medical record system, with the goal of amplifying oncologists' influential roles in motivating health behavior change among survivors. These scalable strategies may be applicable beyond oncology to clinical contexts where greater promotion of patients' health behavior change is desired.