Appl Clin Inform 2024; 15(02): 282-294
DOI: 10.1055/s-0044-1782619
Research Article

Provider Perceptions of an Electronic Health Record Prostate Cancer Screening Tool

Sigrid V. Carlsson
1   Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
2   Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
3   Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
4   Division of Urological Cancers, Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden
Mark Preston
5   Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Andrew Vickers
2   Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Deepak Malhotra
6   Organizations, and Markets Unit, Harvard Business School, Boston, Massachusetts, United States
Behfar Ehdaie
1   Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Michael Healey
7   Brigham and Women's Hospital Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
8   Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Adam S. Kibel
5   Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Funding This project was supported by the Prevent Cancer Foundation. Work done by S.V.C., B.E., and A.V. was supported in part through a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30-CA008748) to Memorial Sloan Kettering Cancer Center. S.V.C. was further supported by a National Institutes of Health/National Cancer Institute Transition Career Development Award (K22-CA234400). A.S.K. is supported by the DiNovi Family Fund.


Objectives We conducted a focus group to assess the attitudes of primary care physicians (PCPs) toward prostate-specific antigen (PSA)-screening algorithms, perceptions of using decision support tools, and features that would make such tools feasible to implement.

Methods A multidisciplinary team (primary care, urology, behavioral sciences, bioinformatics) developed the decision support tool that was presented to a focus group of 10 PCPs who also filled out a survey. Notes and audio-recorded transcripts were analyzed using Thematic Content Analysis.

Results The survey showed that PCPs followed different guidelines. In total, 7/10 PCPs agreed that engaging in shared decision-making about PSA screening was burdensome. The majority (9/10) had never used a decision aid for PSA screening. Although 70% of PCPs felt confident about their ability to discuss PSA screening, 90% still felt a need for a provider-facing platform to assist in these discussions. Three major themes emerged: (1) confirmatory reactions regarding the importance, innovation, and unmet need for a decision support tool embedded in the electronic health record; (2) issues around implementation and application of the tool in clinic workflow and PCPs' own clinical bias; and (3) attitudes/reflections regarding discrepant recommendations from various guideline groups that cause confusion.

Conclusion There was overwhelmingly positive support for the need for a provider-facing decision support tool to assist with PSA-screening decisions in the primary care setting. PCPs appreciated that the tool would allow flexibility for clinical judgment and documentation of shared decision-making. Incorporation of suggestions from this focus group into a second version of the tool will be used in subsequent pilot testing.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the institutional review board at both BWH and MSK.


S.V.C. has received travel reimbursement and speaker honorarium from Ipsen and has served on an advisory board for Prostatype Genomics, unrelated to this study.


The funding agencies had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit it for publication. The content is solely the responsibility of the authors.

Supplementary Material

Publication History

Received: 12 September 2023

Accepted: 12 February 2024

Article published online:
10 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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