It is estimated there will be nearly 1.7 million newly diagnosed cancer patients this year in the U.S. The initial oncology visits for a newly diagnosed cancer patient represent a critical focus for provider-patient communication. This communication involves complex decision-making and emotions, which directly impact patient self-efficacy, confidence, trust, understanding of the disease process and treatment options, and ultimately choice of and adherence to treatment. It has been reported that some newly diagnosed patients leave their oncology appointments with a suboptimal understanding of their disease process, care plan and treatment options, which may influence their decision-making and adherence to recommended therapies. The use of the electronic health record (EHR) during clinic visits has changed the dynamics of patient-provider communication. Increasingly, research has focused on how to use EHR in a patient-centered way to enhance patient-provider communication and patient engagement during a clinic visit. To date, most such research has been conducted in the primary care setting. However, the primary care setting focuses on chronic disease management, acute minor illness, and healthy lifestyle/prevention. The situation is different for the initial oncology visits, where typically multiple different treatment options (some potentially toxic), their associated risks and side effects and impact on survival and disease progression or recurrence are discussed for curable to potentially rapidly fatal diseases. Therefore, it is important to extend the existing knowledge base to better understand how the EHR use in the oncology setting impact communication, trust and address patient's information needs about the specific cancer, extent of disease, treatment options and prognosis. In addition, mental workload, defined as the total amount of mental effort being used in the working memory, is a well- studied human factors phenomenon. How people process information is influenced by mental workload, which is a critical aspect of doctor-patient communication, especially in highly demanding situations, like new patient oncology visits. Using technologies such as EHRs have introduced additional cognitive workload to providers during clinic visits. However, no studies have examined the mental workload of a patient during a clinic visit. To address this gap in the literature, we propose to study the following specific aims study aims in this study: 1): Assess the patient perception of the impact of EHR use on patient-doctor communication, trust and cognitive workload in new patient oncology visits. 2): Identify and cluster patterns of doctor-patient communication with regards to EHR use in the visit using systems engineering tools. The results from our investigation will have necessary data for future funding applications that will further determine how to best incorporate and design requirements for patient-centered EHR use in outpatient oncology settings.

Public Health Relevance

This proposed pilot study addresses the perception of newly diagnosed cancer patients on their initial consultations with oncology providers. Results from these analyses will provide important patient-centered insights into determining how best to incorporate EHR use in oncology settings to improve patient-provider communication of information that is essential for delivering high-quality, patient-centered care. This pilot study will also provide important initial findings and necessary data for future funding applications that will further determine how to best incorporate and design requirements for patient-centered EHR use in outpatient oncology settings with the ultimate goal of enhancing patient-provider communication to optimize patient understanding, trust, engagement of their treatment decisions and ensure the delivery of high-quality, patient- centered cancer care.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Academic Research Enhancement Awards (AREA) (R15)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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Bough, Kristopher J
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Stevens Institute of Technology
Schools of Arts and Sciences
United States
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