Table 1 Rapid cycle approaches to validate nudges and optimize clinical work flow
Domain | Initial approach | Iterative work | Output |
|---|---|---|---|
Clinician nudge | Best practice alert (BPA) identifying patient tobacco use and potential referral to tobacco use treatment. Key questions: -Specific message content -Format and timing of alert -Pre-selected referral -Best method to understand why a referral order may not be appropriate | Method: Usability testing with clinician end-users, with specific questions focused on understanding of what the system was trying to convey, key action(s) to be taken, likes/dislikes of the prototype, and any missing elements Key feedback: -Overall satisfaction with simple and concise design -Alert should be available when first opening the clinical encounter -Pre-select desired outcome | Clinician best practice alert created as an opt-in default, options for accountable justification, and guidance for when in the clinical encounter the BPA should appear. |
Patient nudge | Informational message describing importance of tobacco use treatment during cancer care and available evidence-based treatment options Key questions: - Best method to deliver message (for example, via text message, patient portal, or traditional mail) | Method: Focus group comprised of cancer patients and caregivers viewed the message and provided responses to open-ended questions about its potential impact. Options for how the messages should be delivered were also reviewed and feedback on mode and timing was ascertained. Key feedback: -Send message through patient portal -Suggested wording improvements to clarify treatment options | Deliver patient nudge via patient portal with key wording changes |
Identifying cancer patients who use tobacco | BPA prompting key staff to inquire about tobacco use Key questions: Which staff were best positioned to inquire about tobacco use? | Method: The BPA to assess patient tobacco use was initiated to evaluate compliance, trial randomization, and potential contamination, but with the nudges enacted in silent mode. Key feedback: We failed to include key staff conducting these assessments across several clinical sites who were not included in our original study. | Extend BPA to the full spectrum of staff responsible for initial patient contact |