Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 7:17:2069-2081.
doi: 10.2147/JMDH.S455281. eCollection 2024.

Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients

Atsuko Sugiyama  1   2   3 , Hayato Okumiya  1 , Katsuhiko Fujimoto  1 , Kazuki Utsunomiya  1 , Yuka Shimomura  2 , Masaru Sanuki  4 , Keitaro Kume  4 , Takahiro Yano  4 , Rina Kagawa  5 , Hiroko Bando  6
Affiliations

Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients

Atsuko Sugiyama et al. J Multidiscip Healthc. .

Abstract

Purpose: The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care.

Patients and methods: We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented.

Results: The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints.

Conclusion: The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.

Keywords: breast cancer care; breast cancer multidisciplinary team; patient perspectives; patient-centered care; psychosocial information; shared decision-making.

Plain language summary

An important paradigm shift within healthcare is the shift toward patient-centered care and away from disease-centered treatment. Patient-centered care is based on shared decision-making, respecting an individual patient’s preferences, needs and values, and considering social context and best available research evidence to improve the quality of care. A multidisciplinary team (MDT) approach plays an important role in patient-centered care and MDTs are already adopted into daily oncology practices in many countries, especially in breast cancer care. Previous studies have shown that an effective MDT needs more patient-centered information but often that patient-centered information is notably absent from medical records. We investigated if and how patient-centered information such as psychosocial entries exists in patient records. For this purpose, we performed an exploratory pilot study in which the patient records of three patients with breast cancer, including two patients with advanced stage disease, were studied throughout their care pathway. We observed that the documentation of patient-centered information was fragmented and scattered across various medical records written by multidisciplinary professionals. Moreover, these pieces of scattered information were recorded from different perspectives and viewpoints. Our findings point to a significant role that healthcare informatics could play, as integrating the various healthcare professionals’ electronic health record could likely produce multifaceted and more holistic patient-centered information which could be shared and used in shared decision-making and MDTs with a view to considering both patient and clinical perspectives, potentially improving the quality of care.

PubMed Disclaimer

Conflict of interest statement

Dr. Hiroko Bando, Dr. Rina Kagawa, Dr. Masaru Sanuki, Dr. Keitaro Kume and Dr. Takahiro Yano have received research grants from Canon Medical Systems Corporation. Atsuko Sugiyama, Hayato Okumiya, Katsuhiko Fujimoto, Yuka Shimomura and Kazuki Utsunomiya are Canon Medical Systems employees in research role. The authors have been particularly careful at eliminating any perception of bias. Atsuko Sugiyama is a doctoral course student at the Graduate School of Biomedical Engineering, Tohoku University. Atsuko Sugiyama, Hayato Okumiya and Katsuhiko Fujimoto report a patent US18/460945 pending to Canon Medical Systems Corporation.

Figures

Figure 1
Figure 1
Example of the text annotation. The words with the colored background were tags. Patient Views and Preferences-Care-Treatment and Physical Status-Pain tags were given to the first line, and Contextual Features-Family and Contextual Features-Visit-Admission tags were given to the second line. The author made this figure’s text as an example.
Figure 2
Figure 2
The prototyped application to integrate all annotated results. (a) The numbers represent the number of given tags for each tag. (b) We created QOL dedicated display because QOL category has more tags than other categories. (c) The list of paragraphs containing tagged sentence are displayed by selecting a tag or tags of interest. Author made this figure’s data as an example.
Figure 3
Figure 3
The number and ratio of given BMI and PCI tags to the text of Physician and Nurse/AHP in each case. (a) The table of the number of tags. (b) The graphs of the ratio in each case.
See this image and copyright information in PMC

References

    1. Cancer Research UK. Treatment options for breast cancer. Available from: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/tr.... Accessed December 16, 2023.
    1. Clarke M, Collins R, Darby S, et al.; Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–2106 doi:10.1016/S0140-6736(05)67887-7. - DOI - PubMed
    1. Morris AD, Morris RD, Wilson JF, et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J Sci Am. 1997;3(1):6–12. - PubMed
    1. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):15–23. doi:10.1097/PRS.0b013e3182729cde - DOI - PubMed
    1. Le Tourneau C, Delord JP, Gonçalves A, et al. SHIVA investigators. Molecularly targeted therapy based on tumour molecular profiling versus conventional therapy for advanced cancer (SHIVA): a multicentre, open-label, proof-of-concept, randomised, controlled Phase 2 trial. Lancet Oncol. 2015;16(13):1324–1334. doi:10.1016/S1470-2045(15)00188-6 - DOI - PubMed

LinkOut - more resources