Patient Perceptions of Using Clinical Decision Support for Cancer Screening and Prevention: “I wouldn’t have thought about getting screened without it.”

Purpose: We sought to gain an understanding of cancer prevention and screening perspectives among patients exposed to a clinical decision support (CDS) tool because they were due or overdue for certain cancer screenings or prevention. Methods: Semi-structured qualitative interviews were conducted with 37 adult patients due or overdue for cancer prevention services in 10 primary care clinics within the same health system. Data were thematically segmented and coded using qualitative content analysis. Results: We identified three themes: 1) The CDS tool had more strengths than weaknesses, with areas for improvement; 2) Many facilitators and barriers to cancer prevention and screening exist; and 3) Discussions and decision-making varied by type of cancer prevention and screening. Almost all participants made positive comments regarding the CDS. Some participants learned new information, reporting the CDS helped them make a decision they otherwise would not have made. Participants who used the tool with their provider had higher self-reported rates of deciding to be screened than those who did not. Conclusions: Learning about patients’ perceptions of a CDS tool may increase understanding of how patient-tailored CDS impacts cancer screening and prevention rates. Participants found a personalized CDS tool for cancer screening and prevention in primary care useful and a welcome addition to their visit. However, many providers were not using the tool with eligible patients

Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Introduction Human papillomavirus (HPV) vaccination rates are low in young adults. Clinical decision support (CDS) in primary care may increase HPV vaccination. We tested the treatment effect of algorithm-driven, web-based, and electronic health record-linked CDS with or without shared decision-making tools (SDMT) on HPV vaccination rates compared to usual care (UC). Methods In a clinic cluster-randomized control trial conducted in a healthcare system serving a largely rural population, we randomized 34 primary care clinic clusters (with three clinics sharing clinicians randomized together) to: CDS; CDS+SDMT; UC. The sample included young adults aged 18–26 due for HPV vaccination with a study index visit from 08/01/2018–03/15/2019 in a study clinic. Generalized linear mixed models tested differences in HPV vaccination status 12 months after index visits by study arm. Results Among 10,253 patients, 6,876 (65.2%) were due for HPV vaccination, and 5,054 met study eligibility criteria. In adjusted analyses, the HPV vaccination series was completed by 12 months in 2.3% (95% CI: 1.6%–3.2%) of CDS, 1.6% (95% CI: 1.1%–2.3%) of CDS+SDMT, and 2.2% (95% CI: 1.6%–3.0%) of UC patients, and at least one HPV vaccine was received by 12 months in 13.1% (95% CI: 10.6%–16.1%) of CDS, 9.2% (95% CI: 7.3%–11.6%) of CDS+SDMT, and 11.2% (95% CI: 9.1%–13.7%) of UC patients. Differences were not significant between arms. Females, those with prior HPV vaccinations, and those seen at urban clinics had significantly higher odds of HPV vaccination in adjusted models. Discussion CDS may require optimization for young adults to significantly impact HPV vaccination. Trial Registration clinicaltrials.gov NCT02986230, 12/6/2016

Theories and Documents of Contemporary Art : A Sourcebook of Artists' Writings

Edited by Stiles and Selz, this collection of well known artists' writings and critical texts by North American and European artists/authors draws attention to key moments in the evolution of late-modern art. The texts – manifestos, theoretical essays, interviews, letters, etc. – are placed within one of the following nine categories: Gestural Abstraction; Geometric Abstraction; Figuration; Material Culture and Everyday Life; Art and Technology; Installations, Environments and Sites; Process; Language and Concepts. Includes brief introductions to each chapter. Bibliography. Index. Circa 1300 bibl. ref