Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial

Thomas E. Elliott, Patrick J. O'Connor, Stephen E. Asche, Daniel M. Saman, Steven P. Dehmer, Heidi L. Ekstrom, Clayton I. Allen, Joseph A. Bianco, Ella A. Chrenka, Laura A. Freitag, Melissa L. Harry, Anjali R. Truitt, Jo Ann M. Sperl-Hillen

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Despite decades of research the gap in primary and secondary cancer prevention services in the U. S. remains unacceptably wide. Innovative interventions are needed to address this persistent challenge. Electronic health records linked with Web-based clinical decision support may close this gap, especially if delivered to both patients and their providers. Objectives: The Cancer Prevention Wizard (CPW) study is an implementation, clinic-randomized trial designed to achieve these aims: 1) assess impact of the Cancer Prevention Wizard-Clinical Decision Support (CPW-CDS) alone and CPW-CDS plus Shared Decision Making Tools (CPW + SDMTs) compared to usual care (UC) on tobacco cessation counseling and drugs, HPV vaccinations, and screening tests for breast, cervical, colorectal, or lung cancer; 2) assess cost of the CPW-CDS intervention; and 3) describe critical facilitators and barriers for CPW-CDS implementation, use, and clinical impact using a mixed-methods approach supported by the CFIR and RE-AIM frameworks. Methods: 34 predominantly rural, primary care clinics were randomized to CPW-CDS, CPW + SMDTs, or UC. Between August 2018 and October 2020, primary care providers and their patients who met inclusion criteria in intervention clinics were exposed to the CPW-CDS with or without SDMTs. Study outcomes at 12 months post index visit include patients up to date on screening tests and HPV vaccinations, overall healthcare costs, and diagnostic codes and billing levels for cancer prevention services. Conclusions: We will test in rural primary care settings whether CPW-CDS with or without SDMTs can improve delivery of primary and secondary cancer prevention services. The trial and analyses are ongoing with results expected in 2021.

Original languageEnglish (US)
Article number106271
JournalContemporary Clinical Trials
StatePublished - Mar 2021

Bibliographical note

Funding Information:
This study is supported by a grant from National Cancer Institute : R01 CA193396 .

Publisher Copyright:
© 2021 Elsevier Inc.


  • Clinical decision support
  • Cluster-randomized trial
  • Health informatics
  • Implementation research
  • Primary & secondary cancer prevention
  • Shared decision making


Dive into the research topics of 'Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial'. Together they form a unique fingerprint.

Cite this