Austin Jessica D, Finney Rutten Lila J, Fischer Kristin, Ridgeway Jennifer, Minteer Sarah, Griffin Joan M, Pachman Deirdre R, Ruddy Kathryn J, Cheville Andrea
Division of Epidemiology, Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ.
Division of Epidemiology, Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
JCO Oncol Pract. 2025 Feb;21(2):209-217. doi: 10.1200/OP.24.00280. Epub 2024 Aug 6.
The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors.
Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months.
Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months.
EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.
强化电子健康记录（EHR）促进癌症症状控制（E2C2）试验是一项队列整群随机、阶梯式楔形、II型混合试验，该试验利用EHR系统促进协作护理模式（CCM）方法，目标是改善癌症症状管理。了解影响护理团队采用EHR系统的因素仍然是一个关键的、研究不足的领域。本研究考察了肿瘤护理团队在实施E2C2 EHR系统前对其可行性、可接受性和适宜性的认知如何与实施3个月后的采用情况相关联，并按个体和系统层面因素对采用情况的差异进行了特征描述。
护理团队成员在其各自序列实施E2C2之前和之后3个月完成一项电子调查。采用情况定义为对与旨在促进CCM方法的护理团队导向EHR系统一致的陈述的使用频率。卡方检验评估采用情况的差异，而逻辑回归模型估计可接受性、可行性和适宜性的基线平均得分与3个月时护理团队采用情况之间的关联。
94名护理团队成员（37.2%为肿瘤学家，72.6%为女性，55.3%担任该角色6年以上）的结果发现，采用率在48.9%至71.7%之间，不同地点（社区医疗保健系统与三级医疗中心）和专业角色存在显著差异。在调整专业角色后，在基线时报告更高水平的感知可接受性和适宜性的护理团队成员在3个月时采用EHR系统的几率更大。
在我们的样本中，被认为可接受和适宜的EHR系统更有可能被肿瘤护理团队采用。未来的实施工作应考虑采用量身定制的策略，以促进采用旨在推广基于CCM方法的EHR系统，从而改善癌症症状管理。
