Decision support software to help primary care physicians triage skin cancer - A pilot study

Objective: To determine whether decision support software can help primary care physicians proficiently triage lesions suggestive of basal cell and squamous cell carcinoma. Design/Measures: Physicians selected triage options for 15 digitized images of skin lesions, with and without use of the decision support software. Participants/Settings: Twenty primary care physicians practicing in a health maintenance organization or a city health clinic. Intervention: Decision support software designed to help physicians arrive at a triage recommendation consisted of a clinical information form, a decision tree, and support features (teaching points, example images, and diagrams). Results: Without using the decision support software, physicians chose the wrong triage decision 36.7% of the time; using the decision support software, they chose the wrong response only 13.3% of the time. Not using the decision support software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions 22.1% of the time; using the software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions only 3.6% of the time. Physicians scored an average of 3 points (of a possible 15 points) higher when they used the software (signed rank, 101.0; P<.001). They scored an average of 1 point higher on the 7 cancerous lesions when they used the software (signed rank, 65.5; P<.001). Conclusions: Use of decision support software could improve primary care physicians' triage decisions for lesions suggestive of nonmelanoma skin cancer, and potentially reduce morbidity and health care costs. We are designing a larger study to evaluate the accuracy and utility of the software with patients seen in clinical practice.