Background: Clinical decision support (CDS) designed to encourage discussions between patients and their primary care providers may help improve cancer screening and prevention rates. Our objective was to understand patients’ perspectives on both cancer prevention and screening and a personalized CDS tool among those exposed to the CDS tool because they were due or overdue for cancer screening (breast, colon, lung, cervical) or prevention (human papillomavirus vaccination, tobacco, overweight).
Methods: We conducted semi-structured, qualitative interviews with 37 adult patients due or overdue for cancer prevention and screening services in 10 primary care clinics within intervention arms of a randomized control trial in a health care system serving a largely rural population. We conducted interviews immediately following a visit with a primary care provider. We thematically segmented and coded transcribed interview data using qualitative content analysis.
Results: We identified 3 overarching themes: 1) the CDS had more strengths than weaknesses, with the latter providing areas for improvement; 2) cancer prevention and screening facilitators and barriers identified were mainly at the patient level, but lack of using the CDS by some providers was the only provider-level barrier noted; and 3) discussions and decision-making varied by type of cancer prevention and screening. Almost all participants made positive comments regarding the CDS. Some participants learned new information, reported the CDS helped them make a decision they otherwise would not have made, and found the recommendations helpful in making a decision with their provider. Only 1 of the patients eligible for lung cancer screening reported speaking with their provider about it. Participants who described using the tool with their provider did have higher self-reported rates of making a choice than those who did not.
Conclusion: Participants generally approved of a personalized CDS tool for cancer screening and prevention in primary care, finding it useful and a welcome addition to their visit. However, we found some providers did not use the CDS with eligible patients, suggesting adoption issues that future research should assess, along with the impact of the CDS on screening rates. Other researchers could also apply the patient interview framework we developed in understanding patient perspectives and care needs.