JMIR Publications

ABSTRACT

Background:

Primary care professionals (PCPs) are responsible for identifying eligibility and supporting patient decisions for a wide range of recommended screenings. However, the number of screening recommendations (n = 42 in France for adults), complexity of eligibility criteria, competing priorities in consultations, limited time, and insufficient opportunities for patients who consult infrequently hinder the systematic delivery of screenings. Clinical decision support systems (CDSSs) with patient decision aids may help structure prevention-focused consultations and support shared decision making, but their feasibility and acceptability in routine primary care remain uncertain. As part of the ADER (Aide aux DEpistages Recommandés) research program, we developed Lianeli, a CDSS designed to provide individualized, patient-centered support for all national recommended screenings.

Objective:

The primary objective of ADER-F is to assess the Feasibility of implementing Lianeli in routine primary care by estimating the proportion of patients for whom the CDSS is used completely. Secondary objectives are to (1) quantitatively and qualitatively describe implementation feasibility, (2) describe organizational adjustments and interprofessional work related to the intervention, (3) explore the influence of interprofessional use of Lianeli, health literacy, and social deprivation on feasibility, and (4) estimate the proportion of patients for whom the intervention is likely to improve participation in organized and opportunistic cancer screenings.

Methods:

ADER-F is a noncomparative, multicenter feasibility study with a mixed methods design conducted in primary care in the Auvergne–Rhône-Alpes region, France. We plan to recruit 210 adult patients from 21 GPs across 17 sites. During a routine consultation, eligible patients will be invited to complete a self-administered digital health questionnaire in Lianeli, which applies guideline-based algorithms to identify recommended screenings. Within 60 days, patients will attend a dedicated screening consultation during which the GP will review and validate the questionnaire, discuss benefits and harms of each screening using shared decision making, and plan or update the patient’s screening pathway. Quantitative data will include Lianeli metadata, sociodemographic characteristics, health literacy (HLS-EU16), social deprivation (EPICES score), implementation feasibility measures (GUIDES-based questionnaires), and usability measures (F-SUS). Semi-structured interviews and focus groups with patients and PCPs will provide qualitative data, analyzed thematically and integrated with quantitative findings in a convergent meta-synthesis.

Results:

Recruitment is planned to start in 2026, with a 6-month inclusion period and total study duration of 12 months.

Conclusions:

ADER-F will provide evidence on the feasibility and acceptability of a patient-centered CDSS to support recommended screenings in French primary care. The findings will identify determinants of successful implementation, guide possible developments in the Lianeli software and care pathways, and determine whether a subsequent effectiveness study is justified. Clinical Trial: ClinicalTrials.gov NCT07270926 ; https://clinicaltrials.gov/study/NCT07270926