Clinician Nudge to Gynecologic Oncology Referral at Suspected Ovarian Cancer Diagnosis: A Pilot Study
Introduction
Only two-thirds of patients with ovarian cancer ever see a gynecologic oncologist. Our objective was to examine the feasibility of an electronic health record-based nudge to clinicians for referral to gynecologic oncology at suspected ovarian cancer by imaging.
Methods
We developed a nudge, a short behavioral economics informed best practice advisory with a pended referral order for gynecologic oncology, for primary care, emergency medicine, and obstetrician/gynecology clinicians for when a patient had a O-RADS 4 or 5 lesion on imaging and had not already seen gynecologic oncology. In 2024, clinicians were sent the nudge within 2 business days of a patient’s abnormal imaging through the electronic health record. Our primary outcome was referral rate to gynecologic oncology compared to a historic cohort of patients with O-RADS 4 or 5 lesions from 2020-2023.
Results
In this prospective cohort study, we sent 20 clinician nudges for gynecologic oncology referral; six clinicians (30%) responded that the nudge changed their referral behavior. The 90-day referral rate was 75% compared to historic baseline of 61%. In the pilot, 92% patients undergoing surgery for complex adnexal mases had surgery with gynecologic oncology compared to historic baseline of 82%. One in four patients in the pilot were diagnosed with cancer, all early-stage disease.
Conclusions
A clinician nudge for gynecologic oncology referral at suspected ovarian cancer diagnosis was acceptable and associated with 75% referral rate. A clinician nudge standardizes gynecologic oncology referral and may improve early detection of ovarian cancer. A randomized controlled trial of the clinician nudge is warranted.