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Open Access 01-12-2019 | Care | Research article

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

Authors: 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

Published in: BMC Health Services Research | Issue 1/2019

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.

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Title: Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study
Authors: 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
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-4326-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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