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Research Letter
June 27, 2019

Effect of Introducing a Default Order in the Electronic Medical Record on Unnecessary Daily Imaging During Palliative Radiotherapy for Adults With Cancer: A Stepped-Wedge Cluster Randomized Clinical Trial

Author Affiliations
  • 1Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Penn Center for Cancer Care Innovation at the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 4Penn Medicine Nudge Unit, Penn Medicine Center for Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 5Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
  • 6Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 7Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 8Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
  • 9Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Oncol. Published online June 27, 2019. doi:10.1001/jamaoncol.2019.1432

Annually in the United States, about 250 000 patients with advanced cancer receive palliative radiotherapy to lessen pain, control bleeding, or improve quality of life. To ensure reproducible positioning, patients are immobilized on laser-aligned treatment tables and have standard weekly imaging during treatment. Daily imaging, using radiography or computed tomography, can augment positioning. Although daily imaging is often used for curative radiotherapy, national guidelines consider it unnecessary for palliative radiotherapy.1,2 Unnecessary imaging can increase treatment time and expense for patients in distress.

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