JMIR Publications

ABSTRACT

Background:

A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. This scoping review assessed the state of the science on 1) the effectiveness of health information technology (HIT)-based interventions at supporting secondary cancer prevention in primary care, and 2) the implementation of these interventions.

Objective:

This study aimed 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 / 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 for U.S.-based references from 2015-2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. References were dual-screened using a review criteria checklist. Data extraction was guided by the RE-AIM framework, the Integrated Technology Implementation Model, the Expert Recommendations for Implementing Change taxonomy, and Proctor et al’s implementation strategy reporting domains.

Results:

One hundred and one studies met inclusion criteria. Most involved electronic health record (EHR)-based HIT interventions (84%). The most common HIT function was clinical decision support, primarily as used for panel management (56%) or at the point of care (48%). Fewer than 25% of these studies were related to breast and cervical cancer screening; more than 50% were related to colorectal cancer screening. Improvements in cancer screening were associated with HIT-based interventions in most studies (colorectal: n=36 (66% of colorectal cancer-relevant studies), breast: n=9 (64% of breast cancer-relevant studies), and cervical: n=7 (70% of cervical cancer-relevant studies)). Fewer than 25% of the included papers reported on the reach, adoption, or maintenance of certain interventions. Reported barriers and facilitators to HIT adoption primarily related to inner and outer context factors. Implementation strategies for HIT adoption were reported in less than 25% of included studies. Equity in the interventions’ reach to racial/ethnic minority patient populations was reported in 34% of 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 to support 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. Clinical Trial: Not applicable