JMIR Publications

ABSTRACT

Background:

Delayed cancer diagnosis leads to poorer outcomes. Unintended weight loss (UWL) is a non-specific symptom associated with cancer and other serious conditions, which can make it complex to identify the underlying cause. Clinical Decision Support Systems (CDSS) can provide evidence-based recommendations to facilitate timely investigation and diagnosis.

Objective:

To pilot the implementation of a CDSS for improving early cancer detection in primary care patients with UWL.

Methods:

Five practices reviewed patients identified by the UWL CDSS. Staff were interviewed on acceptability and feasibility of the CDSS. Interviews were analysed thematically using two relevant frameworks: Acceptability of Healthcare Interventions and the Sociotechnical Model for Evaluation of Digital Interventions Framework. Clinical audits assessed correct identification of UWL, follow-up rates and patient characteristics.

Results:

Of 60 patients identified by the CDSS as potentially having UWL, 36 (60%) had true UWL. Among the misclassified cases, most patients were intentionally trying to lose weight; this intention was documented as free text in the clinical notes for 98% of patients and in a structured field for only 20% of patients. Practices recalled five UWL patients (14%) for further follow-up. Interestingly, 94% of UWL patients had received follow-up investigations, including pathology tests, imaging, and/or specialist referrals. This high follow-up rate was true even before the implementation of the CDSS. One-third of patients had no additional symptoms, while 36% had recorded additional abdominal symptoms. Mental health conditions accounted for 19% of diagnoses linked to UWL consultation. Practice staff were generally receptive to the UWL CDSS concept. It was particularly appreciated by practices with strong quality improvement processes and prior CDSS experience. High proportion of misclassified patients, poor workflow integration and conflicting patients’ agenda were cited as implementation barriers.

Conclusions:

Our study revealed challenges and potential benefits of implementing a CDSS for identifying patients with UWL at risk of cancer in primary care. While integration issues and misclassification of patients were noted, high rates of follow-up care were observed regardless of the CDSS. These high follow-up rates prompt consideration of whether they reflect Australian primary care and whether a CDSS with these characteristics is the most appropriate approach to support early cancer detection. Future research should focus on improving CDSS integration with existing workflows, enhancing correct identification through access to clinical notes and utilisation of more sophisticated digital methods (AI). These findings highlight the potential of CDSS in improving patient care and the complexities involved in their successful implementation. Clinical Trial: N/A