Abstract
Background. Early cancer detection is crucial for patient outcomes. Clinical Decision Support Systems (CDSS) have been developed to assist with decision-making about screening or symptomatic assessment in primary care, but implementation remains challenging. Aim. The aim of this study was to compare barriers to implementation of cancer-specific CDSS for screening and symptomatic presentation in primary care. Design and Setting. Systematic mixed-methods literature review. Methods. We conducted a sub-analysis within a systematic review. Qualitative and quantitative data on barriers were coded into themes guided by the Theoretical Domains Framework. Frequencies of studies mentioning barriers were compared between CDSS for cancer detection and other conditions, and between cancer-CDSS for screening and symptomatic presentation. Results. 29 cancer-specific CDSS were identified, addressing screening (n=15) and symptomatic presentation (n=14), with a further 70 addressing other conditions. There were minimal differences in barriers for cancer-specific CDSS and other CDSS. There were differences between cancer-specific CDSS for screening and symptomatic presentation. Barriers more frequently reported for CDSS for symptomatic presentation involved workflow integration (n=9, 64% vs n=4, 27%), medicolegal uncertainty (n=4, 29% vs n=0, 0%), requirements of skills (n=7, 50% vs n=2, 13%), interference with decision-making processes (n=6, 43% vs n=2, 13%), and negative emotions (n=8, 57% vs n=4, 27%). Conclusion. The function and healthcare context of CDSS in the diagnostic process (symptomatic assessment or screening decision-making) appears to be more relevant to implementation than the targeted condition. Involving stakeholders to clarify medicolegal issues and workflow integration is essential for the implementation of CDSS for symptomatic presentation.
- Received September 3, 2025.
- Accepted November 25, 2025.
- Copyright © 2025, The Authors
