Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4326-4 |
| _version_ | 1829483243540316160 |
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| author | Melissa L. Harry Anjali R. Truitt Daniel M. Saman Hillary A. Henzler-Buckingham Clayton I. Allen Kayla M. Walton Heidi L. Ekstrom Patrick J. O’Connor JoAnn M. Sperl-Hillen Joseph A. Bianco Thomas E. Elliott |
| author_facet | Melissa L. Harry Anjali R. Truitt Daniel M. Saman Hillary A. Henzler-Buckingham Clayton I. Allen Kayla M. Walton Heidi L. Ekstrom Patrick J. O’Connor JoAnn M. Sperl-Hillen Joseph A. Bianco Thomas E. Elliott |
| author_sort | Melissa L. Harry |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-14T22:03:23Z |
| format | Article |
| id | doaj.art-898df3ff0852401ca405c16e02ced747 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-14T22:03:23Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-898df3ff0852401ca405c16e02ced7472022-12-21T22:45:55ZengBMCBMC Health Services Research1472-69632019-07-0119111310.1186/s12913-019-4326-4Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative studyMelissa L. Harry0Anjali R. Truitt1Daniel M. Saman2Hillary A. Henzler-Buckingham3Clayton I. Allen4Kayla M. Walton5Heidi L. Ekstrom6Patrick J. O’Connor7JoAnn M. Sperl-Hillen8Joseph A. Bianco9Thomas E. Elliott10Essentia Institute of Rural HealthHealthPartners InstituteEssentia Institute of Rural HealthEssentia Institute of Rural HealthEssentia Institute of Rural HealthEssentia Institute of Rural HealthHealthPartners InstituteHealthPartners InstituteHealthPartners InstituteEssentia Health – Ely ClinicHealthPartners InstituteAbstract 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.http://link.springer.com/article/10.1186/s12913-019-4326-4Cancer screeningClinical decision supportKey informantsPre-implementationPrimary and secondary preventionPrimary care |
| spellingShingle | Melissa L. Harry Anjali R. Truitt Daniel M. Saman Hillary A. Henzler-Buckingham Clayton I. Allen Kayla M. Walton Heidi L. Ekstrom Patrick J. O’Connor JoAnn M. Sperl-Hillen Joseph A. Bianco Thomas E. Elliott Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study BMC Health Services Research Cancer screening Clinical decision support Key informants Pre-implementation Primary and secondary prevention Primary care |
| title | Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study |
| title_full | Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study |
| title_fullStr | Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study |
| title_full_unstemmed | Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study |
| title_short | Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study |
| title_sort | barriers and facilitators to implementing cancer prevention clinical decision support in primary care a qualitative study |
| topic | Cancer screening Clinical decision support Key informants Pre-implementation Primary and secondary prevention Primary care |
| url | http://link.springer.com/article/10.1186/s12913-019-4326-4 |
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