EHR Nudge
Trial question
What is the role of algorithm-based electronic health record defaults in patients with cancer?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
49.0% female
51.0% male
N = 562
562 patients (274 female, 288 male).
Inclusion criteria: adult patients with advanced lung or noncolorectal gastrointestinal cancer identified via electronic health record algorithm.
Key exclusion criteria: hospice care; no scheduled medical oncology follow-up appointment; no medical oncology visit in the prior 24 weeks; no prior electronic health record data; scheduled visits for benign hematology, genetics, or survivorship.
Interventions
N=296 automated algorithm-based palliative care (default palliative care referral via electronic health record with clinician opt-out and accountable justification).
N=266 peer comparison alone (weekly clinician reports detailing palliative care referral rates relative to peers).
Primary outcome
Successful completion of palliative care consultation at 12 weeks
43.9%
8.3%
43.9 %
32.9 %
21.9 %
11.0 %
0.0 %
Automated algorithm-based palliative
care
Peer comparison
alone
Significant
increase ▲
NNT = 2
Significant increase in successful completion of palliative care consultation at 12 weeks (43.9% vs. 8.3%; OR 8.9, 95% CI 5.5 to 14.6).
Secondary outcomes
Borderline significant decrease in the rate of systemic therapy within 14 days of death (6.5% vs. 16.1%; OR 0.3, 95% CI 0.1 to 0.7).
No significant difference in late hospice referral (9.8% vs. 13.8%; OR 0.6, 95% CI 0.3 to 1.1).
Significant decrease in mean Functional Assessment of Chronic Illness Therapy-Palliative Care at 24 weeks (1.4 points vs. 1.2 points; MD -0.5, 95% CI -0.8 to -0.2).
Conclusion
In adult patients with advanced lung or noncolorectal gastrointestinal cancer identified via electronic health record algorithm, automated algorithm-based palliative care was superior to peer comparison alone with respect to successful completion of palliative care consultation at 12 weeks.
Reference
Ravi B Parikh, William J Ferrell, Yang Li et al. Algorithm-Based Palliative Care in Patients With Cancer: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2025 Feb 3;8(2):e2458576.
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