Primary care clinicians’ opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study

Harry, Melissa L.; Chrenka, Ella A.; Freitag, Laura A.; Saman, Daniel M.; Allen, Clayton I.; Asche, Stephen E.; Truitt, Anjali R.; Ekstrom, Heidi L.; O’Connor, Patrick J.; Sperl-Hillen, Jo Ann M.; Ziegenfuss, Jeanette Y.; Elliott, Thomas E.

doi:10.1186/s12913-021-07421-0

Table 4 Provider perspectives on the EMR for cancer prevention and screening by survey and study arm

From: Primary care clinicians’ opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study

	Pre-Implementation Survey					Post-Implementation Survey
Survey Questions	n	UC n (%)	CDS n (%)	CDS + SDMT n (%)	p	n	UC n (%)	CDS n (%)	CDS + SDMT n (%)	p
Select “yes” or “no” for the following questions on the EMR your clinic uses for screening of breast, cervical, colorectal, or lung cancers or HPV vaccination.
The EMR alerts me that this action is due.
Breast Cancer Screening	156	56 (96.6)	50 (90.9)	40 (93.0)	0.506^a	171	66 (100)	50 (96.2)	51 (96.2)	0.247^a
Pre-post within arm p^b		0.217^a	0.439^a	0.654^a
Cervical Cancer Screening	155	20 (35.1)	18 (32.7)	12 (27.9)	0.745	172	29 (43.9)	29 (54.7)	23 (43.4)	0.409
Pre-post within arm p^b		0.317	0.021	0.117
Colorectal Screening	153	54 (94.7)	49 (90.7)	36 (85.7)	0.310^a	172	64 (97.0)	48 (90.6)	49 (92.5)	0.380^a
Pre-post within arm p^b		0.662^a	0.975	0.329^a
Lung Screening	153	41 (73.2)	35 (63.6)	21 (50.0)	0.062	169	56 (86.2)	43 (84.3)	40 (75.5)	0.287
Pre-post within arm p^b		0.075	0.016	0.010
HPV Vaccination	153	39 (70.9)	44 (80.0)	30 (69.8)	0.429	168	41 (65.1)	37 (71.2)	37 (69.8)	0.758
Pre-post within arm p^b		0.499	0.286	0.996
The EMR makes it easy for me to order the needed service.
Breast Cancer Screening	154	49 (87.5)	44 (80.0)	37 (86.1)	0.520	171	58 (87.9)	42 (80.8)	46 (86.8)	0.522
Pre-post within arm p^b		0.949	0.920	0.915
Cervical Cancer Screening	153	30 (53.6)	34 (61.8)	28 (66.7)	0.403	170	44 (67.7)	34 (65.4)	36 (67.9)	0.953
Pre-post within arm p^b		0.112	0.702	0.897
Colorectal Screening	153	51 (91.1)	40 (74.1)	37 (86.1)	0.048	172	63 (95.5)	45 (84.9)	47 (88.7)	0.130^a
Pre-post within arm p^b		0.468^a	0.166	0.698
Lung Screening	149	42 (75.0)	30 (56.6)	26 (65.0)	0.128	172	57 (86.4)	40 (75.5)	41 (77.4)	0.273
Pre-post within arm p^b		0.110	0.043	0.189
HPV Vaccination	148	40 (74.1)	43 (82.7)	30 (71.4)	0.391	167	44 (69.8)	35 (68.6)	36 (67.9)	0.975
Pre-post within arm p^b		0.612	0.960	0.713
The EMR enables me to print out materials that help patients identify their preferred screening method.
Breast Cancer Screening	151	18 (32.7)	20 (37.0)	11 (26.2)	0.530	165	17 (26.2)	25 (50.0)	20 (40.0)	0.030
Pre-post within arm p^b		0.430	0.183	0.163
Cervical Cancer Screening	149	16 (29.1)	17 (32.1)	9 (22.0)	0.547	165	16 (24.6)	25 (50.0)	16 (32.0)	0.016
Pre-post within arm p^b		0.581	0.064	0.285
Colorectal Screening	148	19 (34.6)	22 (43.1)	14 (33.3)	0.548	165	18 (27.7)	26 (52.0)	20 (40.0)	0.029
Pre-post within arm p^b		0.418	0.373	0.509
Lung Screening	148	18 (33.3)	18 (34.0)	11 (26.8)	0.726	163	23 (35.9)	26 (52.0)	20 (40.8)	0.220
Pre-post within arm p^b		0.767	0.064	0.164
HPV Vaccination	145	20 (38.5)	21 (40.4)	10 (24.4)	0.228	160	17 (26.6)	23 (48.9)	20 (40.8)	0.047
Pre-post within arm p^b		0.172	0.393	0.100
The EMR makes it easy to calculate cancer risks for individual patients.
Breast Cancer Screening	152	4 (7.1)	5 (9.1)	3 (7.3)	0.932^a	170	8 (12.1)	11 (21.6)	12 (22.6)	0.256
Pre-post within arm p^b		0.544^a	0.073	0.051^a
Cervical Cancer Screening	153	5 (8.9)	4 (7.3)	2 (4.8)	0.861^a	170	5 (7.7)	9 (17.3)	9 (17.0)	0.216
Pre-post within arm p^b		0.806	0.144^a	0.105^a
Colorectal Screening	153	6 (10.7)	6 (10.9)	4 (9.5)	1.000^a	168	5 (7.7)	8 (15.4)	13 (25.5)	0.031
Pre-post within arm p^b		0.564	0.493	0.061^a
Lung Screening	151	14 (25.5)	9 (16.4)	6 (14.6)	0.329^a	169	15 (22.7)	13 (25.5)	20 (38.5)	0.146
Pre-post within arm p^b		0.726	0.247	0.011
HPV Vaccination	152	10 (18.2)	6 (10.9)	3 (7.1)	0.262^a	166	6 (9.2)	7 (14.3)	12 (23.1)	0.113
Pre-post within arm p^b		0.151	0.603	0.048^a

Note. Chi-square. Yes responses shown. CDS Clinical Decision Support, SDMT Shared Decision-Making Tool, UC Usual Care
^aFisher’s Exact Test
^bComparing pre- and post-implementation survey responses within study arms

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