Simulation testing of a cancer risk decision support tool for general practice

Opportunity

Early cancer detection in general practice is challenging because many cancers first present with nonspecific symptoms – such as unintended weight loss – that are easily attributed to more common conditions.

Clinical decision support systems (CDSSs) embedded in GP electronic health records offer a promising way to flag cancer risk at the point of care. However, even well-designed, usable, and acceptable CDSSs face low uptake in real-world settings, often because they interfere with clinical workflow or clinicians lack the time to engage with them.

Testing these tools before clinical deployment is critical, but doing so in live clinical settings carries risk.

Intervention

The simulation lab provided a purpose-built environment to evaluate a CDSS designed to identify patients presenting with unintended weight loss who may be at risk of undiagnosed cancer. The SimLab's simulated general practice clinic – complete with GP workstations and integrated electronic medical record systems running on the two most widely used GP software platforms in Australia – allowed the tool to be tested in near-real conditions without any risk to actual patients.

Ten GPs each conducted two simulated consultations with trained patient actors across four hypothetical patient scenarios, varying by sex and cancer risk level. Researchers observed consultations through a one-way mirror, with video, audio, and screen recording capturing GP interactions with both the tool and the patient. Following the simulations, in-depth interviews were conducted with GPs, patient actors, and cancer survivors acting as lived-experience community advocates – providing a multimodal picture of how the tool performed in practice.

Impact of simulation

The simulation found that the CDSS was acceptable to all participants and unobtrusive in the consultation. However, its impact on doctor-patient communication varied, facilitating and hindering interactions depending on the GP's communication style. Some GPs used the tool openly as a communication aid, involving patients in decision-making; others used it silently as a checklist, which patient actors and community advocates noted could create a communication gap. This finding emerged directly from observation of simulated consultations, and underscored the potential need for communication-focused training prior to real-world implementation.

The simulation also found that only a minority of GPs accessed the tool's embedded additional resources – a finding the authors suggest may reflect either strong trust in the core content or the additional cognitive load required to navigate less readily available information. These insights are intended to inform future CDSS development and implementation, helping ensure the tool is ready for use in clinical practice.