Patient-Centered Clinical Decision Support for Recommended Screenings in French Primary Care: Protocol for a Multicenter Mixed Methods Feasibility Study

Vollständiger Abstract

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Background Primary care professionals (PCPs) are responsible for identifying eligibility and supporting patient decisions for a wide range of recommended screenings. However, the number of recommendations (42 for adults in France), complex eligibility criteria, limited consultation time, and competing priorities hinder their systematic delivery. Clinical decision support systems (CDSSs) with patient decision aids may help structure prevention-focused consultations and support shared decision-making, but their feasibility and acceptability in routine primary care remain uncertain. As part of the Aide aux Dépistages Recommandés (ADER) research program, we developed Lianeli, a CDSS designed to provide individualized, patient-centered support for all nationally recommended screenings. Objective ADER-Faisabilité (ADER-F) is a study with the primary objective of assessing the feasibility of implementing Lianeli in routine primary care by estimating the proportion of patients for whom the CDSS is used to completion. Secondary objectives are to (1) quantitatively and qualitatively describe implementation feasibility, (2) describe organizational adjustments and interprofessional work related to the intervention, (3) explore the association between interprofessional use of Lianeli, health literacy, social deprivation, and feasibility, and (4 and 5) estimate the proportion of eligible, overdue or never screened patients who engage in organized or opportunistic cancer screening, respectively. Methods ADER-F is a noncomparative, multicenter feasibility study with a mixed methods design conducted in primary care centers in the Auvergne-Rhône-Alpes region in France. We plan to recruit 210 adult patients from 21 general practitioners (GPs) across 17 sites. During routine consultations, eligible patients will be invited to complete a self-administered digital health questionnaire in Lianeli, which applies guideline-based algorithms to identify recommended screenings. Within 60 days, patients will attend a dedicated screening consultation during which the GP will validate the patient’s responses, discuss benefits and harms of each screening using shared decision-making, and update the patient’s screening pathway. Quantitative data will include Lianeli metadata, sociodemographic characteristics, health literacy, social deprivation, implementation feasibility measures (Guideline Implementation with Decision Support [GUIDES]–based questionnaires), and usability measures (French version of the System Usability Scale [F-SUS]). Semistructured interviews with patients and PCPs will be analyzed thematically and integrated with quantitative findings in a convergent metasynthesis. Results The ADER-F study was funded in 2023. Following ethics approval in October 2025 and French National Commission on Data Protection authorization in February 2026, recruitment started in March 2026, with a planned 2-month inclusion period and an overall study duration of 6 months. The results are expected to be published in 2027. Conclusions ADER-F will provide evidence on the feasibility and acceptability of a patient-centered CDSS to support recommended screenings in French primary care. The findings will identify determinants of successful implementation, guide possible developments of the Lianeli software and care pathways, and determine whether a subsequent effectiveness study is justified. Trial Registration ClinicalTrials.gov NCT07270926; https://clinicaltrials.gov/study/NCT07270926 International Registered Report Identifier (IRRID) PRR1-10.2196/89922