{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:06:35Z","timestamp":1740157595976,"version":"3.37.3"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>\n            Objectives\u2003To compare the ability of different electronic health record alert types to elicit responses from users caring for cancer patients benefiting from goals of care (GOC) conversations.<\/jats:p><jats:p>\n            Methods\u2003A validated question asking if the user would be surprised by the patient's 6-month mortality was built as an Epic BestPractice Advisory (BPA) alert in three versions\u2014(1) Required on Open chart (pop-up BPA), (2) Required on Close chart (navigator BPA), and (3) Optional Persistent (Storyboard BPA)\u2014randomized using patient medical record number. Meaningful responses were defined as \u201cYes\u201d or \u201cNo,\u201d rather than deferral. Data were extracted over 6 months.<\/jats:p><jats:p>\n            Results\u2003Alerts appeared for 685 patients during 1,786 outpatient encounters. Measuring encounters where a meaningful response was elicited, rates were highest for Required on Open (94.8% of encounters), compared with Required on Close (90.1%) and Optional Persistent (19.7%) (p\u2009&lt;\u20090.001). Measuring individual alerts to which responses were given, they were most likely meaningful with Optional Persistent (98.3% of responses) and least likely with Required on Open (68.0%) (p\u2009&lt;\u20090.001). Responses of \u201cNo,\u201d suggesting poor prognosis and prompting GOC, were more likely with Optional Persistent (13.6%) and Required on Open (10.3%) than with Required on Close (7.0%) (p\u2009=\u20090.028).<\/jats:p><jats:p>\n            Conclusion\u2003Required alerts had response rates almost five times higher than optional alerts. Timing of alerts affects rates of meaningful responses and possibly the response itself. The alert with the most meaningful responses was also associated with the most interruptions and deferral responses. Considering tradeoffs in these metrics is important in designing clinical decision support to maximize success.<\/jats:p>","DOI":"10.1055\/a-2247-9355","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T23:50:41Z","timestamp":1705535441000},"page":"204-211","source":"Crossref","is-referenced-by-count":0,"title":["Randomized Comparison of Electronic Health Record Alert Types in Eliciting Responses about Prognosis in Gynecologic Oncology Patients"],"prefix":"10.1055","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7528-0970","authenticated-orcid":false,"given":"Robert Clayton","family":"Musser","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Health System, Durham, North Carolina, United States"},{"name":"Duke Health Technology Solutions, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashaud","family":"Senior","sequence":"additional","affiliation":[{"name":"Duke Health Technology Solutions, Durham, North Carolina, United States"},{"name":"Duke Primary Care, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura J.","family":"Havrilesky","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Buuck","sequence":"additional","affiliation":[{"name":"Duke Health Technology Solutions, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Casarett","sequence":"additional","affiliation":[{"name":"Section of Palliative Care, Department of Medicine, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salam","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Duke Health Performance Services, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany A.","family":"Davidson","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"ref2","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1136\/amiajnl-2011-000743","article-title":"Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study","volume":"19","author":"P J Embi","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1093\/jamia\/ocac191","article-title":"Distinct components of alert fatigue in physicians' responses to a noninterruptive clinical decision support alert","volume":"30","author":"D A Murad","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1055\/s-0039-1700869","article-title":"Evaluating the impact of interruptive alerts within a health system: use, response time, and cumulative time burden","volume":"10","author":"P Elias","year":"2019","journal-title":"Appl Clin Inform"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12911-017-0430-8","article-title":"Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system","volume":"17","author":"J S Ancker","year":"2017","journal-title":"BMC Med Inform Decis Mak"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1055\/s-0043-1768994","article-title":"Refining clinical phenotypes to improve clinical decision support and reduce alert fatigue: a feasibility study","volume":"14","author":"L Samal","year":"2023","journal-title":"Appl Clin Inform"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1093\/jamia\/ocac027","article-title":"Clinician collaboration to improve clinical decision support: the Clickbusters initiative","volume":"29","author":"A B McCoy","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1055\/s-0039-3402757","article-title":"Reducing interruptive alert burden using quality improvement methodology","volume":"11","author":"J D Chaparro","year":"2020","journal-title":"Appl Clin Inform"},{"issue":"03","key":"ref9","first-page":"27","article-title":"Transitioning a fall risk care plan interruptive alert to in-line support","volume":"7","author":"S McDonald","year":"2022","journal-title":"J Inform Nurs"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"103956","DOI":"10.1016\/j.ijmedinf.2019.103956","article-title":"Interrupting providers with clinical decision support to improve care for heart failure","volume":"131","author":"S Blecker","year":"2019","journal-title":"Int J Med Inform"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1055\/a-2040-0578","article-title":"Human-centered design of a clinical decision support for anemia screening in children with inflammatory bowel disease","volume":"14","author":"S D Miller","year":"2023","journal-title":"Appl Clin Inform"},{"issue":"14","key":"ref12","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1001\/jama.300.14.1665","article-title":"Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment","volume":"300","author":"A A Wright","year":"2008","journal-title":"JAMA"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ygyno.2013.04.010","article-title":"Timing of end-of-life care discussion with performance on end-of-life quality indicators in ovarian cancer","volume":"130","author":"M Lopez-Acevedo","year":"2013","journal-title":"Gynecol Oncol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.ygyno.2021.12.009","article-title":"Promoting timely goals of care conversations between gynecologic cancer patients at high-risk of death and their providers","volume":"164","author":"B A Davidson","year":"2022","journal-title":"Gynecol Oncol"},{"issue":"13","key":"ref15","doi-asserted-by":"crossref","first-page":"E484","DOI":"10.1503\/cmaj.160775","article-title":"The \u201csurprise question\u201d for predicting death in seriously ill patients: a systematic review and meta-analysis","volume":"189","author":"J Downar","year":"2017","journal-title":"CMAJ"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.ygyno.2020.03.007","article-title":"Validation of the surprise question in gynecologic oncology: a one-question screen to promote palliative care integration and advance care planning","volume":"157","author":"L A Rauh","year":"2020","journal-title":"Gynecol Oncol"},{"issue":"02","key":"ref17","first-page":"302","article-title":"Predicting 6- and 12-month risk of mortality in patients with platinum-resistant advanced-stage ovarian cancer: prognostic model to guide palliative care referrals","volume":"28","author":"J Foote","year":"2018","journal-title":"Int J Gynecol Cancer"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.artmed.2013.05.002","article-title":"Physicians' responses to clinical decision support on an intensive care unit\u2013comparison of four different alerting methods","volume":"59","author":"A MJ Scheepers-Hoeks","year":"2013","journal-title":"Artif Intell Med"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1055\/s-0042-1757923","article-title":"Real-time user feedback to support clinical decision support system improvement","volume":"13","author":"D Rubins","year":"2022","journal-title":"Appl Clin Inform"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2247-9355.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:25:11Z","timestamp":1730802311000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2247-9355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,17]]},"references-count":18,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2024,3,13]]},"published-print":{"date-parts":[[2024,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2247-9355","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"type":"electronic","value":"1869-0327"}],"subject":[],"published-other":{"date-parts":[[2024,1,17]]},"published":{"date-parts":[[2024,1,17]]}}}