JMIR Publications

ABSTRACT

Background:

Early detection in primary care could improve pancreatic cancer survival, but diagnosis is often delayed due to the low prevalence of the disease, the non-specific nature of early symptoms, and the broad range of conditions and volume of consultations managed by general practitioners (GPs). In Australia, improving pancreatic cancer outcomes, including via earlier diagnosis, is a priority being progressed under the National Pancreatic Cancer Roadmap developed by Cancer Australia. Computerised clinical decision support systems (CDSS) have shown promise in aiding timely cancer diagnosis; however, barriers to adopting CDSS such as mistrust of the recommendations or not being embedded in the clinical workflow remain. Simulation techniques, which offer flexible and cost-effective ways to evaluate digital health interventions, can be used to test CDSS before real-world implementation.

Objective:

To assess the acceptability and feasibility of identifying patients with symptoms associated with pancreatic cancer through a CDSS within a simulated environment.

Methods:

We developed a CDSS that interacted with an electronic health record (EHR) used in general practice to identify patients with symptoms which may indicate pancreatic cancer (unintended weight loss or new-onset diabetes) in a simulation laboratory for digital interventions. We tested it by inviting GPs (N=11) to use the CDSS, with patient actors simulating specific clinical scenarios. We then interviewed GPs about the interaction to assess the acceptability and feasibility of the CDSS in their clinical practice. We used thematic analysis and two relevant frameworks to analyse the data.

Results:

GPs found the CDSS easy to use, unobstructive, and effective as a prompt to consider investigations for people with risk factors for pancreatic cancer. However, they expressed concerns about possible over-testing, financial costs, and the potential for anxiety in patients with a very low probability of having cancer.

Conclusions:

While GPs found the tool useful and compatible with their workflow, concerns about over-testing, lack of evidence, and cost-effectiveness were identified as barriers. GPs favoured a stepwise approach to investigations rather than immediate imaging. Despite the overall acceptability of the tool, additional evidence to underpin clinical recommendations is necessary before implementing a CDSS with these specific recommendations for pancreatic cancer in primary care.