Electronic Medical Record-Based Nudge to Reduce SLNB

University of Pittsburgh Medical Center (UPMC) Health System

Status: Completed

Conditions: Breast Cancer; Estrogen-receptor-positive Breast Cancer

Treatments: Behavioral: Column-based nudge in the EHR; Behavioral: No column-based nudge in the EHR

Study type: Observational

Funder types: Other

Identifiers

NCT06006910

4040

Details and patient eligibility

About

The goal of this prospective, historically-controlled, quality improvement project is to determine whether and to what extent an electronic health record (EHR)-based nudge affects rates of sentinel lymph node biopsy (SLNB) in older women with ER+, early-stage, clinically node negative breast cancer.

Full description

Society of Surgical Oncology (SSO) adopted a series of Choosing Wisely recommendations in an effort to reduce low-value surgeries. One such recommendation, first released in 2016, advocates against routine use of sentinel lymph node biopsy (SLNB) for axillary staging in older women (≥ 70 years old) with early-stage, estrogen receptor positive (ER+), clinically node-negative breast cancer. Data supporting this recommendation were largely retrospective in nature as there were no direct randomized trials testing de-escalation of SLNB in this population of patients. This has led to variability in de-implementation of SLNB, with rates of SLNB use still reaching 50%-60% in some centers.

To address this, the investigators designed an electronic medical record-based column nudge that flags patients meeting Choosing Wisely criteria for omission of SLNB. This was designed to target surgeons in the moments leading up to the first clinic visit with patients where surgical decision-making is planned. In this study, the investigators deployed the column nudge for a 12 month period.

The enrollment number reflects the number of surgeons participating in the study (whom the nudge was deployed to); it is anticipated this group of surgeons will see over 400 patients between the pre-nudge and post-nudge periods.

Enrollment: 7 patients

Sex: Female

Ages: 70+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• early-stage (stages I-III) breast cancer
• clinically node-negative
• ER+ and/or PR+, HER2 not-amplified
• non-metastatic at diagnosis

Exclusion criteria

• under 70 years of age
• breast cancer is that is not ER+ or PR+

Trial design

7 participants in 2 patient groups

Pre-Nudge Deployment into EHR

Description:

Rates of SLNB will be recorded for the 12 month period prior to nudge deployment.

Treatment:

Behavioral: No column-based nudge in the EHR

Post-Nudge Deployment into EHR

Description:

Rates of SLNB will be recorded for the 12 month period following nudge deployment into the EHR.

Treatment:

Behavioral: Column-based nudge in the EHR