EHR ‘nudge’ reduces unnecessary axillary surgery in older breast cancer patients

Editor's Note

An electronic health record (EHR)-based nudge could significantly reduce low-value axillary surgeries in older women with early-stage breast cancer, researchers reported July 17 in JAMA Surgery.

Conducted across eight clinical settings, the initiative significantly cut the rates of low-value sentinel lymph node biopsies (SLNB) by nearly 50% over a 12-month period. The intervention involved embedding a simple "nudge" into the EHR, highlighting patients who met the Choosing Wisely criteria for potentially omitting SLNB. The simplicity and ease of integration of this approach suggest it could be adapted to other medical practices and patient populations to decrease unnecessary medical procedures.

Conducted from October 2021 to October 2023, the nonrandomized controlled trial involved seven breast surgical oncologists from eight outpatient clinics. The study evaluated 387 patients, with a median age of 75, divided into a 12-month control period (194 patients) and a 12-month intervention period (193 patients). The introduction of the EHR nudge led to a 23.1 percentage point drop in SLNB rates, from 46.9% before the intervention to 23.8% after. The adjusted odds ratio indicated a significant reduction in SLNB rates post-intervention (OR 0.26; 95% CI, 0.07 to 0.90; P = .03).

Participating surgeons rated the nudge intervention highly for acceptability, appropriateness, and feasibility. Interviews revealed that the intervention served as an effective reminder of Choosing Wisely guidelines without requiring extra steps during patient visits.