Patients Perceptions of Electronic Health Record use during initial oncology outpatient clinic visits - Project Summary
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.
