Skip to main content

Advertisement

Table 1 Key informant-identified barriers and facilitators to the implementation and adoption of the cancer prevention CDS by CFIR domain and construct (n = 28)

From: Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study

CFIR Domains & Constructs Barriers Count Facilitators Count
I. Intervention Characteristics
 B. Evidence Strength and Quality Concern about inaccuracy or conflicting CDS recommendations compared to healthcare system recommendationsa 9 CDS follows USPSTF recommendations 3
 C. Relative Advantage    CDS improvement over current EHR alerts and tools 18
   Potential for time savings 7
   CDS similar to current EHR alerts and tools 5
 D. Adaptability    Optimize CDS integration into clinic workflow 22
 G. Design Quality and Packaging CDS duplicates or complicates care 11   
II. Outer Setting
 A. Patient Needs and Resources Financial costs to patients 11 Patient self-educationa 10
Patient socioeconomic disparities 5 Patients controlling own healtha 9
Patient transportation issues 4 Organization increasing PCP patient visits from 18 to 22 a daya 8
   Reminders to patientsa 5
   Repeated exposure for patientsa 5
   Focus on prevention over crisis or acutea 5
   Lung cancer screeninga 3
 D. External Policy and Incentives    Positive impact on quality metricsa 11
III. Inner Setting
 C. Culture    Alignment with institutional aimsa 16
 D. Implementation Climate
  1. Tension for change PCP time limitationsa 25 PCP time limitations are manageable 5
Alert fatigue (PCPs and/or patients) 25   
  2. Compatibility Not appropriate for acute visits – annual only 9 CDS appropriate for many visit types 5
Not everything in the EHR is accurate or easy to find 9 Others than PCPs using CDS: 22
RN CDS use issues (e.g., not appropriate for all RN visit types, RN roles can vary by clinic, RN shortage in healthcare system)a 5  RNs using CDS in general 22
    RNs using CDS during Medicare annual Wellness visits 14
    RNs using CDS alongside other PCPs 4
    Clinic rooming staff using CDS 4
   Get CDS printouts to patients before provider (e.g., pre-visit use, before PCP enters room) 18
   Alignment with institutional aimsa 16
   Institution-wide streamlining of EHR alerts 9
   Team model of care 8
  3. Relative Priority Seen as just another initiative 10   
Organization increasing PCP patient visits from 18 to 22 a daya 8   
Lack of institutional initiative prioritization 3   
  4. Organizational Incentives and Rewards    Positive impact on quality metricsa 11
 E. Readiness for Implementation
  2. Available Resources PCP time limitationsa 25   
Not all clinics have color printers - looks better in color 6   
RN CDS use issues (e.g., not appropriate for all RN visit types, RN roles can vary by clinic, RN shortage in healthcare system)a 5   
PCP shortage/burnout 4   
Too few printers 3   
Clinic rooming staff – already crunched for time 2   
  3. Access to Knowledge and Information Does not recall receiving cardiovascular CDS training 8 Providing in-person training on the CDS 16
E-learning not always effective 6 E-learning or webinars are acceptable 6
   Provide PCPs with supporting CDS evidence 6
   Focus on workflow in training 5
   Provide multiple learning points 4
IV. Characteristics of Individuals
 A. Knowledge and Beliefs about the Intervention Concern about inaccuracy or conflicting CDS recommendations compared to healthcare system recommendationsa 9 Patient self-educationa 10
PCP distrust of HPV vaccine or cancer risk calculators 3 Patients controlling own healtha 9
   Reminders to patientsa 5
   Repeated exposure for patientsa 5
   Focus on prevention over crisis or acutea 5
   Lung cancer screeninga 3
  1. CFIR - Damschroder et al. [19]. Sample size (n) refers to number of informants interviewed. Count refers to the number of informants that mentioned a specific barrier or facilitator
  2. aCode fit with two CFIR constructs. Could also be a barrier for one construct and a facilitator for another