De-implementation of Low Value Castration for Men With Prostate Cancer (DeADT)
Cancer of Prostate
About this trial
This is an interventional health services research trial for Cancer of Prostate focused on measuring Prostatic Neoplasms, De-implementation, androgen deprivation therapy, Provider Preferences
Eligibility Criteria
Inclusion Criteria:
- Any provider at participating sites who prescribes ADT for prostate cancer patients
Exclusion Criteria:
- Providers opting out of study
Sites / Locations
- VA Ann Arbor Healthcare System
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
ADT ORDER CHECK ATTESTATION (OR)
PROVIDER SCRIPT (SC)
Experimental: ADT ORDER CHECK ATTESTATION (OR) Order restrictions (Or) operate as an organizational constraint, widely perceived as a forcing function giving providers little leeway to exercise judgment but have a strong evidence-base for changing provider behavior. Study staff will place a "health factor" structured data element in the EMR of patients whose clinic visits study staff have confirmed to be targets for ADT de-implementation. This health factor combined with a low PSA level will trigger the ADT Order Check Attestation Intervention (Or) when the provider places an order for ADT.
Experimental: PROVIDER SCRIPT (SC) The provider script (Sc) is a communication aid to be used and documented as an accountable justification in the electronic medical record. This strategy also has a strong evidence-base for changing provider behavior. Study staff will enter a pre-populated CPRS EMR progress note 1 business day prior to a target clinic visit. The note includes talking points for the provider to help with a discussion. It can be edited and cosigned by the provider, giving a quick and simple way to document the discussion. The progress note template asks providers to indicate whether patient prefers to continue or discontinue low-value ADT. Appropriate documentation of the decision will be tracked for fidelity. We will also have a patient handout entitled: "Living well with prostate cancer: Is hormone therapy still right for you?" as a patient engagement and information resource.