Electronic health record-based nudge intervention and axillary surgery in older women with breast cancer: A nonrandomized controlled trial

Although Choosing Wisely recommendations advocate against the use of sentinel lymph node biopsy (SLNB) use in older women with early-stage, clinically node-negative, and HR+ HER2- breast cancer, it is a practice that is still widely used. To combat this overuse, investigators used an electronic health record–based nudge intervention that targeted surgeons in their first outpatient visit with patients in this population. During the nudge intervention period, unadjusted rates of SLNB decreased by 23.1 percentage points compared with rates during the control period. The investigators concluded that the nudge intervention was easily implementable and could help decrease low-value care both in this and other settings.