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

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, Jo Ann M. Sperl-Hillen, Joseph A. Bianco, Thomas E. Elliott

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


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.

Original languageEnglish (US)
Article number534
JournalBMC Health Services Research
Issue number1
StatePublished - Jul 31 2019

Bibliographical note

Funding Information:
Mary B. Van Beusekom, MS, ELS, MWC for copy editing. Health Partners Institute and Essentia Health. National Cancer Institute R01CA193396. The funding body had no role in the design of the study, collection, analysis, interpretation of data, or in writing the manuscript.

Publisher Copyright:
© 2019 The Author(s).


  • Cancer screening
  • Clinical decision support
  • Key informants
  • Pre-implementation
  • Primary and secondary prevention
  • Primary care
  • Qualitative


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