Clinician Nudge to Referral of Adnexal Masses to Gynecologic Oncology

Abramson Cancer Center at Penn Medicine

Status: Invitation-only

Conditions: Ovarian Cancer

Treatments: Behavioral: Nudge

Study type: Interventional

Funder types: Other

Identifiers

NCT07078409

858390

HT9425-25-1-0243 (Other Grant/Funding Number)

Details and patient eligibility

About

The goal of this study is to test the effectiveness of clinician nudges on referrals to gynecologic oncology in patients with suspected ovarian cancer.

The primary outcome will be whether or not patients were referred to gynecologic oncology within 14 days of their abnormal imaging results. Secondary and exploratory outcomes are whether the gynecologic visit occurred within 60 days of abnormal imaging and the time from abnormal imaging results to gynecologic oncology visit.

Enrollment: 240 estimated patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Eligible clinicians include physicians, physician assistants, and nurse practitioners with eligible patient encounters at sites included in the trial during the study.
• Eligible patient encounters are defined as an emergency room visit, inpatient hospitalization, or outpatient visit during the study period where the patient had associated imaging with suspected ovarian cancer (O-RADS 4 or 5 lesion), identified with the EHR-based tool described above.

Exclusion criteria

• Known diagnosis of ovarian cancer.
• Imaging ordered by gynecologic oncologist.

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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240 participants in 2 patient groups

Nudge

Experimental group

Description:

When the clinician who ordered the imaging that led to randomization receives the test results, a pre-checked referral order to gynecologic oncology for surgical evaluation will appear in the EHR alongside a brief educational explanation. This will constitute the opt-out default referral order (Figure 3). Clinicians will have the option to unclick the referral to opt out and will be asked to indicate the reason from a pre-populated list of choices; if they do not opt out, the referral to gynecologic oncology will proceed. Imaging findings and referral will be communicated to the patient in keeping with the clinician's usual practice. In keeping with routine practice, referred patients will be contacted by gynecologic oncology's new patient coordinators within 72 hours and offered an appointment within 2 weeks at their preferred location.

Treatment:

Behavioral: Nudge

Control

No Intervention group

Description:

Clinicians will receive imaging reports per usual practice (i.e., imaging reports that include O-RADS score with recommendation for gynecologic oncology referral in the report) and can place referral through the usual EHR-based ordering system. If referred, patients will be contacted and scheduled as described above.