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. 2020 Apr 21;22(4):e13188.
doi: 10.2196/13188.

Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study

Anna Janssen  1   2   3 , Candice Donnelly  1   2   3 , Judy Kay  4 , Peter Thiem  5 , Aldo Saavedra  5   6 , Nirmala Pathmanathan  7   8 , Elisabeth Elder  7   8 , Phuong Dinh  8   9 , Masrura Kabir  7   8 , Kirsten Jackson  1   2   3 , Paul Harnett  2   8   9 , Tim Shaw  1   3
Affiliations

Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study

Anna Janssen et al. J Med Internet Res. .

Abstract

Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner.

Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema.

Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5).

Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness.

Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge.

Keywords: clinical informatics; data visualization; eHealth; human-centered design.

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Conflict of interest statement

Conflicts of Interest: The authors declare no financial conflicts of interest. TS, CKC, KJ, AJ, AS, PT, and JK were part of the project team that developed and evaluated the dashboard. The project team members who developed the dashboard were not involved in the evaluation sessions.

Figures

Figure 1
Figure 1
The final prototype of the individual patient dashboard visualizes data for individual patients who have been screened for lymphedema. The prototype dashboard presents a deidentified patient record populated with clinical data. A pseudonym is used for the patient name and medical record number (MRN). This patient has 5 lymphedema index (L-Dex) readings that were taken between January 2012 and April 2014. All the readings are in the normal range for this patient and have been taken on the right side of the body (indicated with green, as opposed to blue for left). The patient had 1 surgery in April. In this figure, the user has clicked on the expand icon (+) next to Surgery 1 to expand the box and see additional details about this procedure. Radiotherapy 1 shows an unexpanded procedure. BMI: body mass index.
Figure 2
Figure 2
The final prototype of the cohort data dashboard visualizes data for the group of patients who have been screened for lymphedema and presents it to the user in a single dashboard. The dashboard is interactive and by default displays a comprehensive overview of all the cohort data available to the user. In this figure, the dashboard is showing data for all patients who have been diagnosed with lymphedema (indicated in purple) and all patients that have had a lymphedema index (L-Dex) measure <10 (indicated in green). BMI: body mass index.
Figure 3
Figure 3
A close-up of one chart on the Cohort Data Dashboard: Nodes Resected.
See this image and copyright information in PMC

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