A nudge intervention in the EHR targeting surgeons can reduce sentinel lymph node biopsy (SLNB) among women who meet the Choosing Wisely criteria for SLNB omission, according to a study published in JAMA Surgery. Neil Carleton, PhD, and colleagues examined data for women meeting the Choosing Wisely criteria for omission of SLNB (aged ≥70 years with cT1 and cT2, cN0, HR+/HER2− breast cancer); a column nudge was embedded into the surgeon’s schedule in the EHR for these patients. The study compared a 12-month preintervention control period with a 12-month intervention period. Unadjusted rates of SLNB decreased by 23.1 percentage points in the intervention period compared with the control period (from 46.9% pre-nudge to 23.8% after). Following nudge deployment, rates of SLNB also declined (adjusted OR, 0.26). The intervention was scored highly by surgeons and helped remind them of potential Choosing Wisely applicability, without the need for additional clicks or actions at the patient visit, which facilitated use.
