Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results

Atlas, Steven J.; Burdick, Timothy E.; Wright, Adam; Breslau, Erica S.; Dang, Tin H.; Wint, Amy J.; Smith, R. W.; Harris, K. A.; Zhou, Li; Haas, Jennifer S.

doi:10.1001/jamanetworkopen.2022.34194

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…Patient factors may include need for education about the meaning of the test results, what follow-up procedures involve, and assessing patient preferences . Practitioner factors such as knowledge of guidelines and improved access to prior test results may also be important …”

Section: Discussionmentioning

confidence: 94%

“…34,35 Practitioner factors such as knowledge of guidelines and improved access to prior test results may also be important. 19 The current study was designed to examine the additive effect of EHR reminders, direct patient outreach, and patient navigation. The EHR reminders alone did not improve follow-up proportions and highlight the limited ability of passive reminders among patients who are overdue for follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Even when primary care clinicians are not the ordering clinician, they often coordinate care with various specialists depending on the cancer screening test result . Moreover, primary care clinicians commonly view themselves as responsible for managing the diagnostic evaluation of all abnormal test results . The large volume of abnormal cancer screening test results, along with increasingly complex recommendations for test completion, leads to considerable burden and potential medicolegal risk .…”

Section: Introductionmentioning

confidence: 99%

“…17,18 Moreover, primary care clinicians commonly view themselves as responsible for managing the diagnostic evaluation of all abnormal test results. 19 The large volume of abnormal cancer screening test results, along with increasingly complex recommendations for test completion, leads to considerable burden and potential medicolegal risk. [20][21][22][23] Few clinicians and practice networks have met the challenge with integrated, population-management systems to comprehensively track all abnormal test results and manage follow-up.…”

mentioning

confidence: 99%

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A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Atlas,

Tosteson,

Wright

et al. 2023

JAMA

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ImportanceRealizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results.ObjectiveTo test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results.Design, Setting, and ParticipantsPragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021.InterventionAutomated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment.Main Outcomes and MeasuresThe primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk.ResultsAmong 11 980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%], P &lt; .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result.Conclusions and RelevanceA multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT03979495

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Atlas,

Tosteson,

Wright

et al. 2023

JAMA

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“…21–23 Evidence suggests that PCPs generally feel inadequately supported by staff and electronic systems while feeling uncertain about their responsibility, with less than half of surveyed PCPs reporting that they were very satisfied with the process of managing abnormal screening results for any cancer type. 24 A recent survey revealed that an overwhelming majority of PCPs support patient participation in MCED clinical trials while the majority also have concerns related to management of positive results. 25…”

Section: Clinical Implications Of Mced Testingmentioning

confidence: 99%

Multicancer Early Detection Tests: An Overview of Early Results From Prospective Clinical Studies and Opportunities for Oncologists

Post,

Braun,

Etzioni

et al. 2023

JCO Oncol Pract

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A multitude of blood-based multicancer early detection (MCED) tests assessing cancer-related alterations in circulating genomic analytes and other associated signatures are currently being developed with the potential to disrupt current single-organ screening paradigms. Pathways for clinical implementation of these novel MCED tests have not been delineated, particularly for the patients with signal positive results requiring additional confirmatory testing. In this overview, we highlight early results from prospective clinical studies testing the efficacy of genomic MCED tests in cohorts of patients without known cancer diagnoses. Additionally, we discuss a proposed professional expansion of the oncology practice relating to the diagnostic workup of individuals found to have an MCED signal positive for cancer. As MCED blood tests have the potential to dramatically upend current cancer screening paradigms and downstream cancer therapy, it is imperative for oncologists to be aware of important clinical studies and the multitude of unanswered questions. The current gaps in the clinical implication of these tests may serve as a meaningful and rewarding expansion of oncology practice.

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Improving follow‐up of abnormal cancer screening results

Nierengarten

2024

Cancer

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This news section offers Cancer readers timely information on events, public policy analysis, topical issues, and personalities. In this issue, clinicians discuss how basic interventions and reminders in the electronic health record can help increase the benefits of timely follow‐up for patients who have abnormal cancer screening results. In addition, the results of two recent studies show that new first‐line therapies for advanced bladder cancer are showing improvements in survival.

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Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results

Cited by 13 publications

References 33 publications

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Multicancer Early Detection Tests: An Overview of Early Results From Prospective Clinical Studies and Opportunities for Oncologists

Improving follow‐up of abnormal cancer screening results

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