Enhancing Primary Care Office Workflow to Prevent Cancer

Each year in the U.S., ≥20,000 women and 14,000 men are affected by HPV-related cancers, including cervical and oropharyngeal cancer. However, in 2020, only 59% of U.S. adolescents aged 13-17 were up-to-date with guideline recommended HPV cancer prevention, with even lower rates for 11–12-year-olds, the recommended age group for HPV cancer prevention. Workflow enhancements that enable nurses to deliver cancer prevention strategies to families seeking such measures, with parent/patient consent, have proven effective in inpatient settings for other preventive interventions. However, they have not yet been evaluated for the prevention of HPV-related cancers in primary care settings. Also, the ways in which organizational readiness for change (resources, motivation, staff attributes, leadership support) moderate the effect of these workflow enhancements has not been studied. We have developed a successful online, interactive, communication education program that will be adapted to train nurses and staff alongside physicians on HPV cancer prevention. We propose testing workflow enhancements for guideline recommended HPV cancer prevention in Western New York and assessing which provider and practice factors moderate the effect of these enhancements. This setting includes a diverse group of rural, urban, and suburban practices, and data infrastructure and analytics that allow practices to evaluate HPV cancer prevention in real time. Our aims are: Aim 1: Apply mixed methods (in-depth interviews and practice surveys) to identify provider- and practice-level barriers and facilitators to implementing workflow enhancements for guideline recommended HPV cancer prevention; Aim 2: Using a 2-arm cluster randomized trial, we will assess the effectiveness of workflow enhancements + HPV communication education (intervention arm) relative to HPV communication education alone (control arm) on guideline recommended HPV cancer prevention for 11-17 year-olds. A secondary aim is to measure the implementation of workflow enhancements using surveys; Aim 3: Measure costs and cost-effectiveness of the interventions. If successful, this study will add a deep understanding of how to make workflow enhancements effective in primary care to reduce HPV-related cancers.