In a study reported in the Journal of Clinical Oncology, Jenssen et al found that electronic health record (EHR)-based nudges to clinicians significantly increased the uptake of tobacco use treatment in patients with cancer who were current smokers.
Study Details
In the trial—performed across 11 sites associated with Penn Medicine’s Abramson Cancer Center—246 clinicians in 95 clusters with a total of 2,146 eligible patients were randomly assigned between June 2021 and July 2022 to one of four strategies: EHR-based nudges to patients only (n = 405), nudges to clinicians only (n = 506), nudges to both (n = 745), or usual care (n = 490).
Nudges were designed to counteract cognitive biases that may reduce tobacco use treatment engagement. The primary outcome measure was tobacco use treatment penetration, defined as the proportion of patients with documented tobacco use treatment referral or a medication prescription in the EHR.
Key Findings
On the intention-to-treat analysis, clinician nudge was associated with significantly greater tobacco use treatment penetration vs usual care (35.6% vs 13.5%; odds ratio [OR] = 3.64, 95% confidence interval [CI] = 2.52–5.24, P < .0001). No significant effect of patient nudge vs usual care was observed (OR = 0.85, 95% CI = 0.61–1.19, P = .34). Compared with advanced practice providers, physicians were less likely to achieve tobacco use treatment penetration (OR = 0.66, 95% CI = 0.52–0.85, P = .001).
In an analysis including only cases in which nudges were successfully received prior to patient-clinician encounters (completer-only analysis; n = 1,795), clinician nudge was associated with significantly greater tobacco use treatment penetration vs usual care (37.7% vs 13.5%; OR = 3.77, 95% CI = 2.73–5.19, P < .0001). No significant effect of patient nudge vs usual care was observed (OR = 1.00, 95% CI = 0.73–1.36, P = .99). Compared with advanced practice providers, physicians were less likely to achieve tobacco use treatment penetration (OR = 0.67, 95% CI = 0.51–0.88, P = .004).
The investigators concluded: “EHR nudges, informed by behavioral economics and aimed at oncology clinicians, appear to substantially increase tobacco use treatment penetration. Adding patient nudges to the implementation strategy did not affect tobacco use treatment penetration rates.”
Brian P. Jenssen, MD, MSHP, of the Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
