Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review

Constance Owens-Jasey, BRIDGE-C2 Implementation Science Center in Cancer Control, Oregon Health & Science University, Portland, OR, United States.
Jinying Chen, Department of Preventive Medicine and Epidemiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States.
Ran Xu, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
Heather Angier, Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States.
Amy G. Huebschmann, Adult and Child Center for Outcomes Research and Delivery Science, Ludeman Family Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
Mayuko Ito Fukunaga, Department of Medicine, UMass Chan Medical School, Worcester, MA, United States.
Krisda H. Chaiyachati, Penn Implementation Science Center in Cancer Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Katharine A. Rendle, Penn Implementation Science Center in Cancer Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Kim Robien, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
Lisa DiMartino, RTI International, Research Triangle Park, NC, United States.
Daniel J. Amante, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States.
Jamie M. Faro, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States.
Maura M. Kepper, Brown School, Washington University, St. Louis, MO, United States.
Alex T. Ramsey, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
Eric Bressman, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Rachel Gold, BRIDGE-C2 Implementation Science Center in Cancer Control, Oregon Health & Science University, Portland, OR, United States.

Document Type

Journal Article

Publication Date

4-30-2024

Journal

JMIR cancer

Volume

10

DOI

10.2196/49002

Keywords

cancer prevention; health information technology; implementation; implementation strategies; scoping review

Abstract

BACKGROUND: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. OBJECTIVE: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. METHODS: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record-based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer-relevant studies; 9/14, 64% of breast cancer-relevant studies; and 7/10, 70% of cervical cancer-relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. CONCLUSIONS: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations.

Department

Exercise and Nutrition Sciences

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