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. 2026 Jan-Dec:33:10732748261424959.
doi: 10.1177/10732748261424959. Epub 2026 Feb 19.

Clinician Nudge to Gynecologic Oncology Referral at Suspected Ovarian Cancer Diagnosis: A Pilot Study

Anna Jo Bodurtha Smith  1   2   3   4 , Shivan J Mehta  3   4   5   6 , Tessa Cook  4   7 , Charlie Chambers  7 , Shavon Rochester  1   2 , Hanna Zafar  4   7 , Lisa Jones  7 , Elizabeth A Howell  2   3 , Anne Marie McCarthy  4   8 , Justin Bekelman  3   4
Affiliations

Clinician Nudge to Gynecologic Oncology Referral at Suspected Ovarian Cancer Diagnosis: A Pilot Study

Anna Jo Bodurtha Smith et al. Cancer Control. 2026 Jan-Dec.

Abstract

IntroductionOnly two-thirds of patients with ovarian cancer ever see a gynecologic oncologist. Our objective was to examine the feasibility of an electronic health record-based nudge to clinicians for referral to gynecologic oncology at suspected ovarian cancer by imaging.MethodsWe developed a nudge, a short behavioral economics informed best practice advisory with a pended referral order for gynecologic oncology, for primary care, emergency medicine, and obstetrician/gynecology clinicians for when a patient had a O-RADS 4 or 5 lesion on imaging and had not already seen gynecologic oncology. In 2024, clinicians were sent the nudge within 2 business days of a patient's abnormal imaging through the electronic health record. Our primary outcome was referral rate to gynecologic oncology compared to a historic cohort of patients with O-RADS 4 or 5 lesions from 2020-2023.ResultsIn this prospective cohort study, we sent 20 clinician nudges for gynecologic oncology referral; six clinicians (30%) responded that the nudge changed their referral behavior. The 90-day referral rate was 75% compared to historic baseline of 61%. In the pilot, 92% patients undergoing surgery for complex adnexal mases had surgery with gynecologic oncology compared to historic baseline of 82%. One in four patients in the pilot were diagnosed with cancer, all early-stage disease.ConclusionsA clinician nudge for gynecologic oncology referral at suspected ovarian cancer diagnosis was acceptable and associated with 75% referral rate. A clinician nudge standardizes gynecologic oncology referral and may improve early detection of ovarian cancer. A randomized controlled trial of the clinician nudge is warranted.

Keywords: O-RADS; behavioral economics; clinician behavior; gynecologic oncology; ovarian cancer.

Plain language summary

Patients with ovarian cancer live longer when treated by a gynecologic oncologist, a surgeon whose focus is gynecologic tumors. Yet one-third of patients with ovarian cancer are never seen by a gynecologic oncologist. In this pilot study, we identified clinicians whose patients had imaging concerning for ovarian cancer. We sent these clinicians a message recommending referral to gynecologic oncology with a pended referral order, also known as a clinician nudge. We found that a clinician nudge to gynecologic oncology referral increased referral rate of suspected ovarian cancer to 75%. Clinicians indicated that the nudge was acceptable, and 30% changed their referral behavior after the nudge. More patients had surgery with gynecologic oncology after the nudge than similar patients not in the study. One in four patients in the pilot were diagnosed with cancer, all early-stage disease. A clinician nudge makes it easy and straightforward to clinicians to refer patients to gynecologic oncology. A nudge may improve early detection of ovarian cancer, and a larger study is warranted.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Clinician nudge for gynecologic oncology referral
See this image and copyright information in PMC

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