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Research

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

Sophie Chima, Jeanette C Reece, Kristi Milley, Shakira Milton, Jennifer G McIntosh and Jon D Emery
British Journal of General Practice 2019; 69 (689): e809-e818. DOI: https://doi.org/10.3399/bjgp19X706745
Sophie Chima
Primary Care Collaborative Cancer Clinical Trials Group;
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Jeanette C Reece
Centre for Epidemiology and Biostatistics;
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Kristi Milley
Primary Care Collaborative Cancer Clinical Trials Group;
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Shakira Milton
Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia.
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Jennifer G McIntosh
Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia.
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Jon D Emery
NHMRC practitioner fellow, Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia.
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Abstract

Background The diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.

Aim To investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.

Design and setting A systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.

Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.

Results Of the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.

Conclusion eCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

  • cancer
  • clinical decision support tool
  • early diagnosis
  • general practitioners
  • primary health care
  • Received June 18, 2019.
  • Revision requested July 29, 2019.
  • Accepted August 26, 2019.
  • © British Journal of General Practice 2019
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British Journal of General Practice: 69 (689)
British Journal of General Practice
Vol. 69, Issue 689
December 2019
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Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review
Sophie Chima, Jeanette C Reece, Kristi Milley, Shakira Milton, Jennifer G McIntosh, Jon D Emery
British Journal of General Practice 2019; 69 (689): e809-e818. DOI: 10.3399/bjgp19X706745

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Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review
Sophie Chima, Jeanette C Reece, Kristi Milley, Shakira Milton, Jennifer G McIntosh, Jon D Emery
British Journal of General Practice 2019; 69 (689): e809-e818. DOI: 10.3399/bjgp19X706745
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Keywords

  • cancer
  • clinical decision support tool
  • early diagnosis
  • general practitioners
  • primary health care

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© 2019 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242