Oncology Information System: A Qualitative Study of Users' Requirements

Evaluation of patient-specific motion management for radiotherapy planning computed tomography using a statistical method

We evaluated the probabilistic randomness of predictions by using individual numerical data based on general data for treatment planning computed tomography (CT) and evaluated the importance of patient-specific management through statistical analysis of our facility's data in lung stereotactic body radiotherapy (SBRT) and prostate volumetric modulated arc therapy (VMAT). The subjects were 30 patients who underwent lung SBRT with fiducial markers and 24 patients who underwent prostate VMAT. The average 3-dimensional (3D) displacement error between the fiducial marker and lung mass in 4DCT of lung SBRT was calculated and then compared with the 3D displacement error between the upper-lobe group (UG) and middle- or lower-lobe group (LG). The duty cycles between the lung tumor and fiducial marker at the <2-mm³ ambush area were compared between the UG and LG. In the prostate VMAT, the Shewhart control chart was analyzed by comparing multiple acquisition planning CT (MPCT) and cone-beam CT (CBCT) during the treatment period. The average 3D displacement errors in 4DCT for the lung tumor and fiducial marker were significantly different between the UG and middle- or lower-lobe group, but there was no correlation with the duty cycle. The Shewhart control chart for 3D displacement errors of the prostate for MPCT and CBCT showed that errors of >8 mm exceeded the control limit. In lung SBRT and prostate VMAT, overall statistical data from planning CT showed probabilistic randomness in predictions during the treatment period, and patient-specific motion management was needed to increase accuracy. A radiotherapy planning CT report showing a statistical analysis graph would be useful to objective share with staff.

Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework

Breast Cancer (BC) is the leading cause of death due to cancer in women. Ensuring equitable, quality-assured and effective care has increased the complexity of BC management. This systematic review reports on the state-of-the art of available literature investigating the enactment of personalized treatment and patient-centered care models in BC clinical practice, building a framework for the delivery of personalized BC care within a Patient-Centered model. Databases were searched for articles (from the inception to December 2020) reporting on Patient-Centered or Personalized Medicine BC management models, assessing success factors or limits. Out of 1885 records, 25 studies were included in our analysis. The main success factors include clearly defined roles and responsibilities within a multi-professional collaboration, appropriate training programs and adequate communication strategies and adopting a universal genomic language to improve patients' involvement in the decision-making process. Among detected barriers, delays in the use of genetic testing were linked to the lack of public reimbursement schemes and of clear indications in timing and appropriateness. Overall, both care approaches are complementary and necessary to effectively improve BC patient management. Our framework attempts to bridge the gap in assigning a central role played by shared decision-making, still scarcely investigated in literature.

Usability evaluation of an integrated electronic medication management system implemented in an oncology setting using the unified theory of the acceptance and use of technology

BACKGROUND

Medication management processes in an Oncology setting are complex and difficult to examine in isolation from interrelated processes and contextual factors. This qualitative study aims to evaluate the usability of an Electronic Medication Management System (EMMS) implemented in a specialised oncology unit using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework.

METHODS

The study was conducted in a 12-bed outpatient Oncology unit of a major teaching hospital 6 months following implementation of a commercial EMMS. In-depth semi-structured interviews were conducted with doctors, nurses and pharmacists using the system to assess usability. The UTAUT framework was used to analyse the results, which facilitated evaluation of interrelated aspects and provided a structured summary of user experience and usability factors.

RESULTS

Direct cross-comparison between user groups illustrated that doctors and pharmacists were generally satisfied with the facilitating conditions (hardware and training), but had divergent perceptions of performance (automation, standardised protocols and communication and documented) and effort (mental and temporal demand) expectancy. In counterpoint, nurses were generally satisfied across all constructs. Prior experience using an alternative EMMS influenced performance and effort expectancy and was related to early dissatisfaction with the EMMS. Furthermore, whilst not originally designed for the healthcare setting, the flexibility of the UTAUT allowed for translation to the hospital environment.

CONCLUSION

Nurses demonstrated overall satisfaction with the EMMS, whilst doctors and pharmacists perceived usability problems, particularly related to restricted automaticity and system complexity, which hindered perceived EMMS success. The study demonstrates the feasibility and utility of the UTAUT framework to evaluate usability of an EMMS for multiple user groups in the Oncology setting.

A Conceptual Model of an Oncology Information System

Introduction

Oncologists are usually faced with a huge amount of diagnostic and therapeutic data in the process of cancer care. However, they do not have access to the integrated data. This research aimed to present a conceptual model of an oncology information system based on the users' requirements.

Methods

This study was conducted in 2019 and composed of two phases. Initially, a questionnaire was designed, and clinical experts (n=34) were asked to identify the most important data elements and functional requirements in an oncology information system. In the second phase, conceptual, structural and behavioral diagrams of the system were drawn based on the results of the first phase. These diagrams were also reviewed and validated by five experts.

Results

Most of the data elements and all functional requirements were found important by the experts. The data elements were related to different phases of cancer care including screening, prevention, diagnosis, treatment, mental care and pain relief, and end-of-life care. Then, conceptual, structural and behavioral diagrams of the system were designed and approved by the experts or revised based on their comments.

Conclusion

The conceptual model and the diagrams presented in the current study can be used for developing an oncology information system. This system will be able to manage patients' cancer data from screening to the end-of-life care. However, the system needs to be designed and implemented in a real healthcare setting to see how it can meet users' requirements.