Clinician nudge at suspected ovarian cancer diagnosis improves oncology referral rate
Key takeaways:
- A clinician nudge at the time of a suspected ovarian cancer diagnosis improved gynecologic oncology referral rates by 20 percentage points.
- A randomized controlled trial of this strategy is planned.
A clinician nudge for referral to a gynecologic oncologist at the time of suspected ovarian cancer diagnosis improved referral rates by 20 percentage points, according to study results.
Nearly a third of clinicians who received the nudges said they would not have made the referrals without them, data presented at Society of Gynecologic Oncology Annual Meeting on Women’s Cancer showed.
“We want to make sure that ovarian cancer is diagnosed as soon as possible, so that women have the best chance at successful treatment and longer survival,” Anna Jo Smith, MD, MPH, assistant professor of gynecologic oncology at University of Pennsylvania Perelman School of Medicine, told Healio. “Timely referral to gynecologic oncology for suspected ovarian cancer is associated with increased rates of evidence-based care and improved survival.”
One-third of patients with ovarian cancer do not visit a gynecologic oncologist, according to study background.
Smith and colleagues conducted a pilot study to evaluate the feasibility of a clinician nudge at the time of suspected ovarian cancer diagnosis, and whether the nudges improved referral to gynecologic oncology.
The researchers used natural language processing of radiology reports to identify 38 patients with imaging suspicious of ovarian cancer. None of the patients had previously been seen in gynecologic oncology at Penn Medicine.
The investigators defined “suspicious” as a radiologist-reported Ovarian-Adnexal Reporting and Data System (O-RADS) scores of 4 or 5 on ultrasound or MRI. A score of 4 equates to a 10% to 49% risk for ovarian cancer, and a score of 5 equates to a risk of 50% or higher.
Within 48 hours of abnormal imaging, the clinician who ordered the imaging received a nudge with a pending order for referral to gynecologic oncology via the electronic health record. The researchers compared referral rates in the group with clinician nudges against a cohort of patients with O-RADS 4/5 lesions detected from 2020 to 2023.
The investigators followed patients for 60 days after abnormal imaging.
Smith and colleagues excluded 18 patients — nine who had 2-week delays in O-RADS scoring due to technical challenges, five whose ordering providers were not available through the electronic health record and four who had been referred to gynecologic oncology before a nudge could be made.
The researchers sent 20 clinician nudges for referrals. Of those, 15 patients (75%) were referred — surpassing the 55% historical baseline referral rate.
Notably, six of the 20 clinicians who received a nudge stated that it “changed their decision-making” and that they would not have made a referral to gynecologic oncology without it, according to the researchers.
Compared with a historical baseline of 20 days, the nudge reduced the mean time from abnormal imaging to referral to 10 days.
Of those referred, the proportion of patients with a gynecologic oncology visit within 90 days of abnormal imaging increased from 56% to 75% (mean, 29 days from abnormal imaging to first visit).
Further, 11 referred patients had surgery with gynecologic oncology, four of whom received a cancer diagnosis at that time. All cancers were stage I.
“We were encouraged to see that the nudge approach used in our pilot study improved referral times and successfully detected early-stage cancer, and look forward to assessing this strategy in a larger, randomized study,” Smith told Healio.
For more information:
Anna Jo Smith, MD, MPH, can be reached at annajo.smith@pennmedicine.upenn.edu.
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Smith AJ, et al. Clinician nudge to gynecologic oncology referral at suspected ovarian cancer diagnosis: A pilot study. Presented at: SGO Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle.